THE  WORK  OF  OUR  HANDS 


The  Work  of  Our 
Hands 

A  Study  of  Occupations  for  Invalids 


BY 

HERBERT  J.  HALL,  M.D. 

AND 

MERTICE  M.  C.  BUCK 


NEW  YORK 

MOFFAT,  YARD  &  COMPANY 
1915 


COPYRIGHT,    1915 

BY  MOFFAT,  YARD  &  COMPANY 


INTRODUCTION 

THE  following  words  appeared  in  a  recent 
Boston  Herald  editorial:  "One  of  the  many 
stultifying  effects  of  war  has  already  found  a 
pathetic  example  in  the  Industrial  Home  for 
Crippled  Soldiers  which  has  been  established  in 
Lyons,  France.  Recognizing  the  terrible  bur- 
den of  incapacitated  men — a  burden  not  only 
on  the  finances  but  on  the  general  esprit  of  the 
country — France  has  taken  the  institution  at 
Charleroi,  Belgium,  as  a  model  for  its  new 
school,  which  will  open  as  soon  as  possible. 
Here,  as  at  Charleroi,  there  will  be  seven  de- 
partments: Shoe-making,  bookbinding,  har- 
ness making,  tailoring,  basketry,  matting 
weaving,  and  bookkeeping.  And  here  thou- 
sands of  men,  most  of  them  young,  many  of 
them  destined  for  careers  of  wide  helpfulness, 
will  come,  grateful  to  pick  up  sufficient  knowl- 
edge to  make  them  partially  or  entirely  self- 
supporting  for  the  rest  of  their  shattered  lives." 
It  is  evident  that  dire  necessity  must  rapidly 

vii 


359152 


viii  INTRODUCTION 

develop  in  Europe  an  industrial  idea  which 
social  thinkers  and  workers  all  over  the  world 
have  been  dreaming  about  and  applying  in  a 
small  way  for  many  years.  The  need  of  ade- 
quate work  for  the  handicapped  in  this  country 
is  not  less  real  than  in  Europe,  if  it  is  less 
strikingly  evident. 

A  war  that  goes  on  year  after  year  between 
the  machine  and  the  man,  between  disease  and 
the  man,  keeps  our  ambulances  busy  and  taxes 
our  charities  in  no  uncertain  way.  The  hospi- 
tals do  their  best,  our  charitable  organizations 
are  very  efficient,  but  there  are  thousands  of 
men  and  women  in  every  great  city  doomed  to 
idleness  and  dependence  because  of  injury  or 
some  illness  that  makes  ordinary  work  out  of 
the  question. 

The  man  out  of  work  because  of  hard  times 
is  badly  enough  off.  What  of  the  man  who 
because  of  some  crippling  or  disfigurement  can 
never  hope  to  work  again?  Put  yourself  in 
that  man's  place — imagine  the  despair  and  the 
final  degeneration  that  must  sap  at  last  all  that 
is  brave  and  good  in  life. 

Then  there  is  the  economic  side.  We  know 
that  wealth  depends  upon  productive  industry. 


INTRODUCTION  ix 

The  really  well  to  do  community  or  the  really 
prosperous  man  must  be  constantly  at  work, 
adding  to  the  world's  store  of  valuable  things. 
The  moment  industries  stop  there  is  waste  and 
desolation. 

Although  the  plight  of  the  handicapped 
workers  in  this  country  is  very  desperate,  much 
has  already  been  done  toward  improvement  of 
their  condition.  Strangely  enough  the  most 
hopeful  progress  has  been  made  among  the  in- 
sane in  the  various  state  hospitals.  It  has  been 
recognized  for  many  years  that  mentally  dis- 
turbed and  depressed  people  are  better  off  and 
get  well  more  quickly  if  their  faculties  can  be 
used  in  some  simple  and  effective  way.  The 
first  steps  that  were  taken  gave  the  patients 
simple  work  to  do  in  the  wards  and  in  the 
service  of  the  institutions.  This  housekeeping 
work  served  a  very  good  purpose,  although  it 
was  no  doubt  occasionally  abused  by  the  over- 
driving of  certain  patients  who  were  willing 
and  able.  On  the  other  hand,  it  left  out  a 
great  many  patients  who  could  not  adapt  them- 
selves to  such  occupations. 

Within  the  last  decade  the  superintendents 
of  these  hospitals  have  generally  realized  that 


x  INTRODUCTION 

by  developing  the  manufacture  of  goods 
needed  by  the  institution  a  great  range  of  pa- 
tients could  be  interested  and  their  work  uti- 
lized. The  visitor  to  one  of  the  more  pro- 
gressive state  asylums  to-day  will  be  deeply 
impressed  with  the  many  activities  which  are 
going  on.  The  patients  participate  in  all  the 
household  work,  especially  in  the  laundry  and 
in  the  kitchen.  They  are  also  employed  in  the 
manufacture  of  clothing,  shoes  and  furniture. 
They  are  making  and  remaking  mattresses, 
and,  best  of  all,  they  are  employed  very  largely 
upon  the  farms  in  the  raising  of  crops  for  the 
use  of  the  institutions.  Officials  everywhere 
acknowledge  that  there  is  no  one  remedy  so 
potent  as  work  in  these  unfortunate  cases. 
Interest  is  aroused,  old  faculties  are  restored, 
and  recovery  is  hastened.  Incidentally  a  very 
great  saving  is  made  to  the  state;  many  thou- 
sands of  dollars  yearly  in  each  institution. 

Very  lately  it  has  been  realized  that  a  certain 
number  of  patients  who  cannot  be  interested  in 
these  more  common  pursuits  will  find  interest 
and  development  in  some  of  the  handicrafts, 
such  as  weaving,  knitting,  and  basket  making. 
The  casual  visitor  will  again  be  surprised  to  see 


INTRODUCTION  xi 

how  far  these  crafts  have  been  followed  and 
what  excellent  work  is  turned  out. 

The  idea  of  occupation  for  the  handicapped 
has  progressed  far  enough  in  this  country  so 
that  it  is  now  rare  to  find  any  institution  for 
chronic  patients  where  there  is  general  idleness. 
The  worst  offenders  in  failure  to  supply  work 
for  the  patients  are  the  private  institutions 
where  people  of  means  are  treated.  Here  it 
will  not  infrequently  be  observed  that  patients 
who  would  be  far  better  off  to  be  occupied  are 
allowed  to  sit  in  idleness  day  after  day,  week 
after  week.  The  day  will  come  when  such 
treatment  of  any  patient  able  to  do  even  a  very 
small  and  unimportant  work  will  be  consid- 
ered a  disgrace. 

The  idea  of  work  for  the  handicapped  both 
as  a  remedy  and  as  a  means  of  partial  self-sup- 
port has  been  developed  lately  in  the  interest 
of  the  many  sufferers  from  chronic  heart  dis- 
ease. Diseases  of  the  heart  unfortunately  at- 
tack most  frequently  those  people  who  are 
engaged  in  the  most  arduous  pursuits,  who  are 
exposed  to  bad  weather,  and  who  must  do 
heavy  lifting  and  work  for  long  hours.  It  has 
been  found  that  after  hospital  treatment  these 


xii  INTRODUCTION 

patients  go  back  to  their  old  occupations. 
There  is  nothing  else  to  do,  and  they  almost 
invariably  relapse  and  have  to  be  treated  all 
over  again.  Until  very  lately  there  has  been 
no  outlook  for  such  cases  except  a  gradual 
going  to  pieces  under  the  existing  conditions. 
A  little  over  a  year  ago  there  was  established 
at  Sharon,  Connecticut,  a  home  for  convales- 
cent heart  cases*  where  the  patients  were 
taught  a  new  trade,  the  making  of  concrete 
flower  pots.  Artistic  molds  were  provided, 
and  the  technic  was  worked  out  in  such  a  way 
that  good  results  were  assured  from  the  tech- 
nical point  of  view.  It  was  found  that  this 
trade  could  be  carried  on  without  overstrain- 
ing the  injured  hearts  of  these  patients,  and 
that  most  of  the  men  grew  stronger  under  the 
work,  because,  as  is  well  known,  a  moderate  ex- 
ercise strengthens  the  heart  that  is  diseased 
just  as  surely  as  overwork  injures  it.  These 
men  have  been  kept  in  the  home  in  Sharon  for 
several  weeks  or  even  months,  then  sent  back 
to  their  homes  in  the  city,  not  to  take  up  their 
old  and  too  strenuous  occupations,  but  to  carry 

*The  workshop  has  recently  been  transferred  to  the  Burke 
Foundation  Convalescent  Home  at  White  Plains,  N.  Y. 


INTRODUCTION  xiii 

on  in  a  specially  supervised  city  work  shop  the 
quiet  trade  which  they  had  acquired  at  Sharon. 
The  astonishing  part  of  this  semi-charitable 
enterprise  is  that  it  has  been  able  to  pay  a  con- 
siderable number  of  handicapped  workers  fair 
wages  from  the  sales  of  the  flower  pots. 

As  is  well  known,  there  are  many  workshops 
for  the  crippled  and  the  blind  in  many  parts 
of  the  country,  all  successful  in  relieving  the 
harm  and  illness  that  are  attendant  upon  idle- 
ness, if  they  are  not  justified  from  the  commer- 
cial and  artistic  point  of  view. 

These  small  beginnings  are  pointing  the  way 
to  very  large  possibilities  of  effective  industries 
for  the  handicapped.  It  seems  likely  that  a 
careful  and  expert  study  of  many  industries 
will  reveal  the  possibilities  of  modification  that 
will  make  the  labor  of  the  handicapped  a  thing 
of  great  power  and  value  in  the  industrial  and 
social  life  of  the  country. 

The  handicap  that  keeps  a  man  from  the 
regular  industries  may  be  very  slight  indeed, 
yet  the  regular  industries  cannot  change  their 
rules  and  system  for  the  sake  of  giving  him 
employment.  Neither  can  we  go  on  forever 
wasting  the  potentialities  of  the  slightly  handi- 


xiv  INTRODUCTION 

capped.  The  way  out  seems  to  lie  in  the  es- 
tablishing of  special  industries  where  the 
handicapped  may  be  favored  and  yet  given  a 
chance  to  use  what  strength  and  intelligence 
they  have. 

The  whole  idea  is  so  simple  it  is  a  wonder 
that  it  was  not  fully  developed  long  ago.  Side 
by  side  with  machine  work  of  many  kinds  are 
the  possibilities  of  more  careful  hand  work  re- 
quiring time  and  intelligence  and  warranting 
both.  Take,  for  instance,  two  trades,  weaving 
and  cement  working.  It  is  evident  that  hand 
weavers  cannot  expect  to  compete  with  the 
power  looms.  Yet  with  care  and  skill  avail- 
able in  a  hand  weaving  shop  it  is  possible  with 
special  oversight  of  the  workers  to  turn  out 
products  which  the  power  looms  could  never 
accomplish  and  which  are  eagerly  sought  be- 
cause of  the  charm  and  interest  which  belongs 
to  a  specially  woven  fabric.  In  the  making  of 
cement  flower  pots  there  could  never  be  the 
hope  of  turning  out  a  cheap  commercial  prod- 
uct by  hand,  but  the  handicapped  workers  at 
Sharon  are  making  such  a  variety  of  new  and 
interesting  shapes,  so  well  decorated  and  col- 


INTRODUCTION  xv 

ored,  that  the  demand  for  the  wares  is  constant 
and  dependable. 

There  are  two  principal  elements  which 
enter  into  the  situation  and  make  it  hopeful. 
First  of  all  the  fact  that  many  of  the  men  and 
women  who  must  avail  themselves  of  these 
special  industries  are  of  unusual  education  and 
capacity.  Secondly,  it  will  be  more  and  more 
feasible  to  call  to  the  consideration  of  the  prob- 
lem the  highest  type  of  able-bodied  industrial 
and  artistic  direction.  There  is  no  reason  why 
these  handicapped  industries  should  not  com- 
mand the  best  engineering  talent  and  the  best 
possible  cooperation  of  designers  and  crafts- 
men. Undirected  and  unsystematized,  special 
industries  of  this  sort  would  undoubtedly  fail 
pathetically.  But  a  small  part  of  the  skill  and 
intelligence  which  is  given  to  the  regular  in- 
dustries will  find  abundant  opportunities  for 
the  handicapped  workers.  In  the  end  the  sys- 
tem may  turn  out  to  be  not  charitable  at  all  but 
a  definite  business  proposition. 

The  problem  is  relatively  simple  in  the  va- 
rious charitable  and  semi-charitable  institu- 
tions. Here  it  is  being  found  that  a  large  part 


xvi  INTRODUCTION 

of  the  necessary  hospital  supplies  can  be  manu- 
factured on  the  premises.  As  for  instance,  in 
one  Massachusetts  asylum  for  the  insane,  where 
cement  bricks  and  tiles  are  made  in  great  quan- 
tities, then  used  in  actual  building  operations 
for  the  state.  And  in  many  other  institutions 
where  a  large  part  of  the  food  supply  is  raised 
on  the  farm  by  the  labor  of  the  patients  who 
are  able  to  do  such  work. 

The  great  difficulty  is  encountered  when  the 
chronic  patient  is  obliged  to  leave  the  institu- 
tion and  go  back  to  his  home.  There  organiza- 
tion ceases  and  he  finds  his  handicap  painfully 
evident.  The  case  of  the  cured  or  partly  cured 
tubercular  patient  and  of  the  cured  insane  is 
pertinent  enough.  These  people,  like  ex-con- 
victs, are  looked  upon  with  suspicion.  They 
are  either  not  wanted  because  their  strength  is 
inadequate  or  because  the  employer  is  afraid 
that  some  accident  will  happen. 

In  increasing  numbers  the  discharged  pa- 
tients of  the  great  institutions  have  learned 
occupations  or  trades  during  the  time  of  treat- 
ment. There  has  already  been  some  talk,  par- 
ticularly in  Massachusetts,  of  the  establishment 
of  outside  workshops  where  under  special  ob- 


INTRODUCTION  xvii 

servation  chronic  patients  discharged  from  the 
hospitals  may  find  opportunity  for  remunera- 
tive work.  At  first  thought  it  seems  impos- 
sible that  any  industry  conducted  for  the  bene- 
fit of  the  handicapped  could  have  successful 
operation  without  large  charitable  support,  but 
a  little  ingenuity  and  persistence  will  in  time 
overcome  this  prejudice. 

Take  for  instance  the  trade  of  laundry  work- 
ing. As  has  been  stated,  a  very  large  number 
of  the  patients,  particularly  in  the  hospitals  for 
the  insane,  are  employed  in  the  laundry. 
There,  although  their  mental  capacity  may  be 
comparatively  small,  they  are  patiently  trained 
to  perform  certain  necessary  parts  of  the  labor. 
Most  of  these  patients  could  not  go  into  a  reg- 
ular steam  laundry  and  succeed.  It  should  be 
quite  possible  to  establish  special  laundries 
where  such  operatives  could  be  successfully  em- 
ployed. The  workers  would  need  to  be  di- 
rected by  officers  who  had  had  experience  in  the 
asylum  laundries,  but  with  such  direction  there 
would  be  little  doubt  of  success.  It  is  possible 
that  such  laundries  might  have  to  be  subsidized 
and  that  their  field  should  be  limited  so  that 
they  would  not  overlap  or  compete  with  the  ex- 


xviil  INTRODUCTION 

isting  industries.  Those  who  know  the  situa- 
tion realize  that  there  is  a  wide  need  of  careful 
hand  laundry  work.  The  machines  tear  and 
destroy  fine  fabrics  too  fast.  These  handi- 
capped workers  might  well  be  trained  to  do  this 
special  slow  work  which  householders  now  find 
great  difficulty  in  getting  accomplished.  A 
special  price  could  reasonably  be  asked  for  such 
work  and  this  would  offset  in  some  degree  the 
slowness  and  intermittent  efforts  of  the  work- 
ers. 

If  the  discharged  and  handicapped  patients 
from  hospitals  all  over  the  country  could  be 
given  legitimate  work  which  would  secure  them 
even  half  of  the  usual  wage,  a  very  great  load 
would  be  lifted  from  charity,  and  a  still  greater 
load  from  the  minds  and  hearts  of  the  workers. 
There  are  many  hard  working  families  in  which 
the  burden  of  one  idle  member  is  a  very  serious 
matter.  If  that  patient  could  be  given  work 
which  would  earn  even  a  very  small  amount  of 
money  the  difficult  atmosphere  of  the  home 
would  be  quite  changed. 

There  is  immediate  and  pressing  need  of  a 
new  system  which  will  modify  old  industries 
and  create  new  ones  that  will  give  the  handi- 


INTRODUCTION  xix 

capped  a  fair  chance.  The  thing  must  be  done 
systematically  and  intelligently.  If  it  is  done 
in  this  way  there  is  no  limit  to  the  industrial 
possibilities.  We  have  been  studying  the  prob- 
lems of  efficiency  for  the  able  bodied  and  with 
astonishing  results.  Careful  study  of  the 
handicapped  and  their  industrial  possibilities 
will  be  well  repaid.  The  thousands  who  are 
now  idle,  not  from  choice  but  because  they  no 
longer  fit  the  regular  industries,  represent  a 
source  of  power  and  of  wealth  that  has  been 
curiously  overlooked.  These  men  and  women 
are  the  waste  human  product  of  the  industrial 
world,  a  product  so  valuable  that  its  use  would 
mean  a  revolution  in  industrial  and  in  charitable 
affairs. 

The  skeptical  will  say  there  is  no  doubt  about 
the  need  of  special  occupations  for  handicapped 
people,  but  basket  making  and  chair  caning 
and  such  crafts  will  not  go  very  far  toward 
the  actual  support  of  thousands  of  needy  peo- 
ple. Such  doubters  have  only  to  visit  the  un- 
promising field  of  the  state  asylums  to  be  quite 
convinced  of  the  enormous  economic  and  moral 
possibilities  of  specialized  work  for  the  handi- 
capped. In  the  workshops  of  these  hospitals 


xx  INTRODUCTION 

may  be  seen  any  day  in  the  year  hundreds  of 
people  contributing  in  no  small  way  to  their 
self  support  by  means  of  carefully  directed 
labor.  The  principle  is  proven  under  these  cir- 
cumstances many  times  over  and  its  applica- 
tion to  the  needs  of  a  much  larger  and  more 
promising  class  outside  the  hospital  is  only  a 
matter  of  detail. 

It  must  not  be  forgotten  that  unemployment 
is  as  harmful  for  the  well  to  do  as  it  is  for  the 
poor.  The  writer  of  these  chapters  undertook 
ten  years  ago  to  meet  in  a  small  way  the  needs 
of  a  class  of  people  who  were  not  in  actual  want 
but  who  from  illness  or  the  overstrain  of  mod- 
ern life  had  been  obliged  to  give  up  their  usual 
occupations.  It  removes  some  of  the  doubt  as 
to  the  practicability  of  special  industries  for  the 
handicapped  to  know  that  a  young  physician 
in  a  small  town  could,  without  capital,  develop 
in  ten  years  three  self-supporting  industries, 
for  the  benefit  of  men  and  women  who  need  to 
bring  back  courage  and  efficiency  through  the 
slow  accomplishment  of  manual  work.  The 
industries  which  have  been  used  are  pottery, 
hand  weaving,  and  cement  working.  That 
none  of  them  have  gone  bankrupt  although 


INTRODUCTION  xxi 

managed  a  good  deal  of  the  time  without  espe- 
cial business  ability  speaks  volumes  for  the  vi- 
tality of  the  idea. 

These  experimental  workshops  began  very 
simply  with  hand  weaving  under  a  compe- 
tent teacher.  This  laid  the  foundation  for  a 
considerable  industry.  The  pottery  served  its 
purpose  as  a  school  for  a  time,  then  became 
professional  and  is  now  in  that  class.  The 
cement  working,  which  is  the  latest  addition, 
promises  well  as  an  industry  and  is  exceedingly 
useful  from  the  medical  point  of  view.  The 
workshops  are  at  present  run  in  connection 
with  a  sanatorium  where  people  of  means  are 
given  the  usual  medical  treatment  for  con- 
valescence and  for  nervous  exhaustion.  The 
shops  themselves  are  conducted  by  profes- 
sional teachers  and  by  assistants  who  come 
as  apprentices  to  learn  the  trades  that  they 
may  in  turn  become  teachers.  These  appren- 
tices have  often  enough  been  themselves  pa- 
tients who  were  obliged  to  make  a  living  and 
who  found  opportunity  in  this  way.  School 
teachers  who  have  broken  down  in  their  work 
have  found  quieter  and  more  practical  occu- 
pation in  this  new  field.  During  the  past  five 


xxii  INTRODUCTION 

years  these  medical  workshops  have  equipped 
nine  people  who  are  now  earning  a  living  in 
other  institutions.  Six  of  these  were  them- 
selves patients,  the  subjects  of  nervous  exhaus- 
tion in  one  form  or  another.  One,  a  teacher 
of  music  who  for  several  years  had  been  quite 
helpless  and  hopeless,  is  now  earning  a  salary 
of  $1200  as  the  head  of  a  social  settlement 
system.  One  is  independent  as  a  teacher  of 
weaving  to  the  blind,  two  are  in  charge  of  hos- 
pital workshops,  and  two  are  earning  their 
living  as  potters. 

The  sales  of  products  from  all  these  work- 
shops amounted  in  the  past  year  to  about 
$5000.  True,  there  was  no  profit,  but  the 
shops  have  given  an  opportunity  for  experi- 
mental work  and  they  have  served  their  pur- 
pose as  a  school  where  people  of  means  who  are 
broken  down  nervously  or  physically  may  grad- 
ually regain  strength  and  efficiency  under 
medical  observation.  Part  of  the  product  of 
this  institution  is  the  result  of  skilled  labor  em- 
ployed for  the  purpose,  and  part  of  the  work  is 
done  by  people  who  had  broken  down  and  who 
have  gradually  regained  strength.  *  It  is  only 
fair  to  say  that  some  of  the  workers  who  were 


INTRODUCTION  xxiii 

not  so  originally  have  become  highly  skilled 
and  should  rank  as  professional.  But  that 
does  not  detract  from  the  significance  of  the 
enterprise.  It  seems  reasonable  to  suppose 
that  similar  and  other  industries  might  be 
established  elsewhere  with  increasing  benefit  to 
the  people. 

Aside  from  important  economic  considera- 
tions medical  men  will  find  that  carefully  con- 
ducted industries  will  add  a  very  strong  new 
remedial  measure  to  their  practice.  If  a 
young  woman  comes  into  the  doctor's  office 
complaining  of  sleeplessness,  fear  of  insanity, 
indigestion  and  nervous  weakness,  the  long 
train  of  trying  symptoms  familiar  to  every 
practitioner,  that  patient  should  be  sent  to 
some  medical  workshop  as  soon  as  she  has  had 
sufficient  rest  to  make  it  possible.  There  un- 
der the  influence  of  quiet  work  she  will  forget 
and  leave  behind  her  such  symptoms  as  are  of 
purely  nervous  origin  and  the  physician  will 
then  be  able  to  tell  with  certainty  how  much 
of  the  trouble  is  physical  and  in  need  of  the 
usual  medical  treatment,  and  how  much  is  to 
be  disposed  of  by  the  acquirement  of  courage 
and  self  control.  There  is  no  better  way  of 


xxiv  INTRODUCTION 

separating  the  real  from  the  imagined,  and  no 
better  way  of  leaving  fear  and  unhappiness 
behind.  Carefully  regulated  work  is  a  remedy 
of  the  first  order.  It  must  be  used  with  dis- 
cretion and  care,  or  like  any  other  remedy  it 
may  do  more  harm  than  good. 

Such  briefly  is  the  idea  of  the  work  cure. 
The  following  chapters  will  consider  in  a  more 
detailed  way  how  the  principle  has  been  or  may 
be  applied  in  charitable  or  private  practice. 

The  first  section  of  the  book,  written  by  Dr. 
Hall,  is  based  upon  his  experience  of  ten  years 
in  building  up  a  series  of  medical  industries 
in  a  private  sanatorium  at  Marblehead,  Mass., 
an  institution  dealing  largely  with  people  of 
means  who  have  been  given  manual  work  as  a 
part  of  the  treatment  of  nervous  disability. 
The  second  section,  written  by  Miss  Buck,  is 
founded  upon  her  experience  of  many  years  in 
the  actual  teaching  of  handicapped  patients, 
mostly  mental  and  organic  nervous  cases  in 
charitable  or  semi-charitable  institutions  in 
New  York  City. 

The  writers  are  indebted  to  the  Board  of 
Directors  and  the  Superintendent  of  the  Lin- 
coln Hospital  and  Home  in  New  York;  and 


INTRODUCTION  xxv 

to  the  supervision  and  hearty  interest  of  the 
Medical  and  Nursing  Staff  and  the  Social 
Service  Director  of  the  Neurological  Institute 
of  New  York  City;  also  to  the  Trustees  and 
Superintendent  of  the  Massachusetts  General 
Hospital  in  Boston;  the  Industrial  School  for 
Cardiac  Convalescents  at  Sharon,  Connecti- 
cut; and  to  a  large  number  of  physicians, 
craftsmen,  teachers  and  patients  without  whose 
assistance  and  encouragement  the  following 
chapters  could  not  have  been  written. 

Free  use  has  been  made  of  the  material  in 
numerous  articles  published  by  Dr.  Hall  from 
time  to  time  in  the  Boston  Medical  and  Sur- 
gical Journal,  and  the  Journal  of  the  Ameri- 
can Medical  'Association. 

Dr.  Hall  takes  this  opportunity  to  acknowl- 
edge with  especial  gratitude  the  assistance  of 
the  craftsmen  and  designers  who  have  from 
time  to  time  devoted  themselves  to  the  problems 
of  his  experimental  work.  These  workers 
have  had  experience  not  only  in  the  developing 
and  the  application  of  crafts  and  trades  for 
handicapped  labor  but  they  have  given  very 
generously  of  their  time  and  strength  to 
the  actual  teaching  of  patients.  The  Misses 


xxvi  INTRODUCTION 

Jennie  and  Ruth  Turner,  both  hand  weavers 
of  the  highest  order,  have  made  possible  a  very 
considerable  progress  along  this  important 
line.  Miss  Margaret  Weddle  has  developed 
a  practical  department  of  dyeing.  Miss  Wed- 
dle's  dyed  yarns  are  now  used  effectively  in 
the  hand- weaving  of  several  institutions.  Miss 
Edith  Griffin  has  now  devoted  several  years 
to  the  difficult  subject  of  cement  working  for 
invalid  workshops — Mr.  Percy  Griffin  has  done 
original  work  in  the  iron  foundries — work  lead- 
ing toward  the  manufacture  of  molds  suitable 
for  cement  castings.  Miss  Jessie  Luther,  now 
an  active  teacher  of  crafts  in  the  service  of  Dr. 
Grenfell  in  Labrador,  deserves  much  credit  for 
pioneer  work  in  weaving.  She  was  the  first 
craftsman  employed  in  the  medical  workshops 
in  Marblehead.  Mrs.  Edwd.  Tutt,  Messrs. 
Arthur  Baggs,  Arthur  Hennessy  and  John 
Swallow  have  made  possible  the  self-support- 
ing pottery.  Miss  Frances  Wood  and  Miss 
Florence  Riley  have  been  able  assistants  in 
cement  working  and  weaving.  Miss  Annie 
Aldrich  and  Miss  Maude  Milner  have  given 
valuable  service  as  designers. 

These  craftsmen  and  their  assistants,  many 


INTRODUCTION  xxvii 

of  whom  have  been  themselves  invalids,  have 
shown  that  self  supporting  workshops  may  be 
run  in  connection  with  a  private  sanatorium — 
they  have  helped  to  make  clear  the  possibilities 
of  a  comprehensive  system  of  industries  for  the 
charitable  institutions. 

The  writers  are  also  indebted  to  Dr.  Walter 
Fernald  and  to  Dr.  Elwood  Worcester.  Both 
these  gentlemen  have  reviewed  the  manuscript 
and  have  given  valued  suggestions  and  en- 
couragement. 


CONTENTS 


CHAPTER  PAGE 

INTRODUCTION vii 

PART  I 

I    WORKSHOPS   IN    GENERAL   HOSPITALS 1 

II     MANUAL  WORK  FOR  PATIENTS  IN  STATE  AND  COUNTY 

HOSPITALS        12 

III  SANATORIUM    TREATMENT    FOR    PEOPLE    OF    SMALL 

MEANS        33 

IV  TEACHER  AND  PUPIL 46 

V    THE  TRAINED  NURSE  AND  THE  WORK  CURE  ...     51 

VI    THE  WELL-TO-DO  PATIENT  AT  WORK 57 

VII    THE  INDUSTRIAL  PROBLEM  OF  THE  TUBERCULAR  .     .     61 
VIII     HANDICAPPED  LABOR  AND  THE  LAW 66 

PART  II 

I  TEACHING   OF  THE   HANDICAPPED 71 

II  METHODS    OF    TEACHING 85 

III  READJUSTMENT 89 

IV  ORGANIC  NERVOUS  DISEASES 95 

V  HYSTERIA 120 

VI    EPILEPSY        128 

CHOREA 133 

VII     MENTAL   DISEASES 142 

VIII     BORDER-LINE    CASES 156 

IX    WORK  WITH   THE   AGED 160 

X    NEURASTHENIA 166 

PSYCHASTHENIA 175 

XI    WORK  WITH  CRIPPLES 180 

APPENDIX 187 


LIST  OF  ILLUSTRATIONS 

Weaving  Room,  Devereux  Mansion  .....    Frontispiece 


PAGE 

Workshop  of  the  Burke  Foundation  Convalescent  Home  .       4 

Knitting    Machines,    Massachusetts     School     for     Feeble- 
minded        ...............     18 

Cement   Flower-pots      ............     42 

Basketry  and  Weaving      ...........     96 

Making  Iron-framed  Canvas  Laundry  Bags  .....  146 

In  the  Wards  of  Lincoln  Hospital  ........  162 

Occupation  Room  at  Hospital  for  Ruptured  and  Crippled  182 


THE  WORK  OF  OUR  HANDS 


THE  WORK  OF  OUR  HANDS 

PART  I 
I 

WORKSHOPS  IN  GENERAL  HOSPITALS 

THE  Massachusetts  General  Hospital  has  with- 
in the  past  year  established  a  medical  workshop 
in  a  basement  of  the  new  out-patient  building. 
This  shop  is  a  hospital  department,  authorized 
by  the  trustees  and  supervised  by  the  executive 
staff.  The  cost  of  running  is  very  little  as 
there  is  but  one  salaried  worker.  The  heat, 
light  and  rent  cost  the  hospital  nothing  as  the 
rooms  are  kept  open  anyway.  The  shop  is 
still  very  small,  accommodating  never  more 
than  six  patients.  It  has,  however,  practically 
paid  for  itself  in  the  first  year  through  the  sale 
of  its  products. 

No  one  doubts  the  need  of  part-time  work 
for  handicapped  people.  The  difficulty  has 
been  to  find  such  employment.  This  hospital 


C;'Y.7  :        THE  WORK  OF  OUR  HANDS 

shop  is  equipped  with  molds  for  the  manufac- 
tures of  cement  flower  pots,  seats,  sundials,  and 
such  garden  accessories.  The  idea  was  care- 
fully tested  and  worked  out  for  two  years  by 
craftsmen  in  the  writer's  experimental  shops  at 
Marblehead,  and  later  in  a  more  elaborate  way 
in  the  studio  of  Mr.  Clarence  Denny  of  Hyde 
Park,  Massachusetts,  who  has  generously  sup- 
plied the  hospital  with  special  appliances.  The 
molds  and  appliances  have  been  so  constructed 
as  to  insure  success  from  the  mechanical  and 
artistic  points  of  view.  Nothing  is  left  to  the 
choice  and  initiative  of  the  workers,  who  are 
elected  from  among  the  chronic  out-patients  of 
the  hospital — people  who  would  otherwise  be 
idle  at  home  or  working  at  some  hard,  unsuit- 
able employment.  This  is,  so  far  as  is  known, 
the  first  attempt  of  a  general  hospital  to  pro- 
vide work  that  can  be  regulated  to  the  capacity 
of  its  crippled  out-patients,  with  the  idea  of 
protecting  these  people  from  the  evil  effects  of 
idleness  or  overwork,  and  for  the  purpose  of 
keeping  them  in  good  physical  and  economic 
condition  so  that  they  will  be  less  likely  to  need 
further  ward  treatment.  The  Shop  at  the 
Massachusetts  General  Hospital  has  employed 


WORKSHOP  IN  GENERAL  HOSPITALS  3 

the  subjects  of  various  disabilities,  including 
paralytics,  accident  cases  with  loss  or  disabling 
of  members,  cases  of  rheumatic  arthritis  and 
post  operative  disability  of  many  kinds. 

The  fact  is  that  this  important  element  of 
adequate  work  for  partly  disabled  patients  has 
never  been  fully  met  by  any  outside  charitable 
agency.  If  the  hospital  is  to  undertake  to  im- 
prove conditions  in  the  life  of  the  patient  after 
his  discharge,  it  may  well  begin  by  providing 
work.  Work  with  a  money  return  must  be  the 
substantial  basis  of  all  such  improvement. 
Without  that  basis,  our  charity  may  often 
enough  be  wasted. 

The  social  service  workers  have  in  the  past 
few  years  accomplished  a  great  deal  in  the 
right  direction.  The  Social  Service  Com- 
mittee of  King's  Chapel  in  Boston  had  in  Miss 
Grace  Harper  a  woman  who  knows  the  trades 
and  who  was  remarkably  successful  in  finding 
work  for  handicapped  people.  But  the  doors 
of  the  regular  industries  are,  often  enough, 
closed  to  the  handicapped.  Business  is  geared 
too  high  to  give  more  than  an  infrequent,  sub- 
ordinate place  to  men  who  are  not  able-bodied. 

It  is  easy  to  believe  that  the  whole  idea  of 


4  THE  WORK  OF  OUR  HANDS 

specialized  work  is  impractical.  If  the  es- 
tablished factories  and  workshops  of  the  world 
must  employ  only  the  most  efficient,  how  can 
charitable  institutions  without  experience  and 
with  crippled  workers  hope  to  accomplish  ade- 
quate results?  This  first  hospital  workshop  in 
Boston  has  begun  to  show  the  possibilities  of  an 
industrial  system  of  tremendous  economic  and 
social  importance.  Not  many  years  ago  the 
great  manufacturing  plants  were  throwing 
away  by-products  that  are  now  worth  their 
annual  millions.  The  industrial  world  is 
throwing  away  untold  values  in  damaged  hu- 
man material,  the  reasonable  salvage  of  which 
might  save  a  great  deal  of  money  and  an 
amount  of  human  suffering  too  great  to  be 
reckoned. 

About  the  same  time  as  the  founding  of  the 
Massachusetts  general  workshop,  a  move- 
ment began  in  New  York  City  to  provide  some 
kind  of  light  work  for  the  cases  of  heart 
disease  that  are  discharged  relieved  from  the 
various  hospitals.  These  cases  of  organic 
heart  disease  are,  of  course,  much  benefited  by 
their  short  sojourns  in  the  hospitals  during 
acute  stages  of  the  disease,  but  they  almost  in- 


WORKSHOP  IN  GENERAL  HOSPITALS  5 

variably  drift  back  into  the  wards  and  they 
are  naturally  worse  each  time.  Having  no 
other  trades  they  attempt  their  old  too  arduous 
and  exposed  occupations.  The  result  is  al- 
ways the  same;  they  break  down  again  and 
again.  Such  a  cycle  is  poor  economy  and 
poor  humanity.  Realizing  this,  the  Burke 
Foundation  financed  the  beginning  of  an  in- 
dustrial school  for  convalescents  at  Sharon, 
Connecticut.  The  idea  of  this  school  is  to 
keep  cardiac  cases  under  favorable  conditions 
for  about  three  months  and  at  the  same  time 
to  teach  them  a  trade,  in  this  case  the  making 
of  cement  flowerpots  and  other  articles  of 
commerce  such  as  those  made  at  Marblehead 
and  in  Boston.  The  first  year's  work  has 
been  so  encouraging  that  two  workshops  have 
been  established  in  New  York  City  so  that  the 
men  who  have  learned  the  trade  in  Sharon 
may  come  back  to  their  homes  in  the  city  and 
go  daily  to  the  city  shops  for  employment. 
The  medical  reports  on  these  heart  cases  are 
most  encouraging.  The  work  can  be  gauged 
exactly  with  experience  so  that  the  patient 
gives  all  the  strength  he  is  able  without  reach- 
ing the  point  of  fatigue.  The  simple  arm 


6  THE  WORK  OF  OUR  HANDS 

motions  of  the  technique  are  as  good  as  espe- 
cially designed  exercises  for  improving  the 
strength  of  the  circulation,  and  yet  as  a  result 
of  these  movements  there  is  a  product  of  im- 
mediate market  value.  The  actual  financial 
possibilities  of  these  hospital  shops  cannot  be 
predicted.  They  will  have  to  be  run  intelli- 
gently and  on  business  principles.  At  the 
present  time  the  shops  show  a  growing  market 
with  encouraging  return.  They  employ  nine 
men  and  pay  nine  dollars  a  week.  A  letter 
from  the  director  says,  "Their  hours  are  from 
nine  to  twelve.  Most  of  the  men  are  exam- 
ined once  a  week  by  a  heart  specialist.  Some 
of  them  have  improved  so  much  that  an  exam- 
ination once  in  two  or  three  weeks  seems  to 
be  enough.  All  of  the  men  have  improved 
one  hundred  per  cent,  since  their  return  from 
Sharon."  At  the  Massachusetts  General  the 
men  and  women  have  been  paid  between  four 
and  six  dollars  a  week.  At  the  end  of  the  first 
year  it  was  found  that  the  shop  had  paid  for 
all  its  equipment  and  supplies,  the  salaries  and 
other  expense,  and  had  a  deficit  of  but  $800.* 
The  cement  garden  and  flower  pots  of  these 

*  This  deficit  has  since  been  wiped  out  by  the  profits  of  special 
sales. 


WORKSHOP  IN  GENERAL  HOSPITALS  7 

institutions  are  only  a  crude  beginning.  If 
the  work  succeeds  so  well  now,  the  future  is 
very  bright,  for  not  only  can  this  kind  of  ware 
be  improved  and  extended,  but  new  manufac- 
tures of  various  kinds  can  be  added.  With 
good  planning  and  time  the  shops  should 
justify  themselves  from  every  point  of  view. 

The  first  requirement  of  development  is 
this:  That  the  new  handicapped  industries 
must  not  attempt  to  compete  with  machinery 
along  the  established  lines.  The  second  re- 
quirement is  an  assured  market  for  all  prod- 
ucts. This  implies  that  the  choice  of  products 
shall  be  wise  and  far-seeing  and  that  the  work- 
manship shall  be  good.  The  third  require- 
ment is  that  the  work  shall  be  of  a  kind 
adaptable  to  physical  and  nervous  limitations. 

If  we  were  to  attempt  to  make  flower  pots 
out  of  clay  as  they  have  been  made  for  gen- 
erations; if  our  shop  force  of  handicapped 
people  were  to  compete  with  the  jigger- wheels 
and  the  enormous  kilns  of  the  great  potteries, 
we  should  not  only  fail,  but  we  would  amply 
deserve  our  failure.  But  we  propose  to  make 
flower  pots  in  a  new  way — out  of  cement  this 
time,  and  cast  in  molds  that  can  be  handled 


8  THE  WORK  OF  OUR  HANDS 

by  a  crippled  girl  quite  as  well  as  by  a  strong 
man.  If  our  molds  are  proportioned  and  de- 
signed by  an  artist  of  full  ability,  then  the 
situation  changes.  The  strong  men  may  bend 
to  their  wheels,  turning  out  cheap  and  rather 
ugly  flower  pots  that  sell,  to  be  sure,  by  the 
hundred  thousand.  The  greater  industry  goes 
its  way,  and  it  will  not  interfere  in  the  slight- 
est degree  with  the  smaller,  slower,  but  equally 
justified,  process. 

This  particular  new  product  gives  to  the 
public  at  a  moderate  price — more  expensive 
than  terra-cotta,  less  expensive  than  glazed 
pottery — a  beautiful  and  useful  article  of 
common  use.  The  material  for  these  cement 
flower  pots  costs  from  three  to  ten  cents  each, 
the  selling  price  is  usually  from  fifty  cents  to 
one  dollar.  Thus  is  the  second  requirement 
fulfilled,  or  as  nearly  fulfilled  as  can  be  the 
case  with  any  new  idea.  We  are  counting  on 
the  well-known  market  for  flower  pots,  and  on 
the  especial  characteristics  and  middle-priced 
value  of  our  ware. 

The  third  requirement  is  more  easily  met 
than  most  of  the  uninitiated  would  suppose 
possible.  Here  is  the  key-note  of  the  success 


WORKSHOP  IN  GENERAL  HOSPITALS  9 

of  all  handicapped  labor.  There  must  always 
be  a  fully  trained  instructor  and  a  sufficient 
number  of  able  assistants.  Handicapped 
workers  alone  are  hopeless  and  helpless;  under 
careful  direction  there  is  no  end  to  their  pos- 
sibilities. 

Cement  working  is  but  one  of  many  possible 
modifications  of  existing  industries.  The 
shops  at  Marblehead,  and  in  many  other 
places,  have  developed  hand-weaving  to  a  high 
degree  of  perfection.  By  our  three  require- 
ments, hand-weaving  is  available  for  convales- 
cent or  permanently  limited  people.  We 
would  be  absolutely  lost  if  we  were  to  attempt 
to  make  on  hand-looms,  cloth  such  as  could  be 
more  readily  made  by  power  machinery.  But 
by  developing  especial  patterns  and  individual 
effects  designed  by  clever  craftsmen,  we  pro- 
vide a  business  capable  of  supporting  a  great 
many  handicapped  workers.  At  Marblehead 
is  made  a  small  woolen  blanket  for  babies. 
The  material  costs  about  sixty  cents.  If  the 
workers  were  to  weave  a  similar  length  and 
width  of  plain  wool,  they  could  not  sell  it  for 
a  dollar,  but  because  there  is  an  attractive  de- 
sign and  because  the  ends  are  finished  well, 


10  THE  WORK  OF  OUR  HANDS 

these  specialized  blankets  sell  for  five  or  six 
dollars.  It  takes  about  a  day  and  a  half  to 
make  one  such  blanket.  The  factories  could 
not  produce  the  same  thing — hand  weaving  is 
distinctive  and  better — but  the  hospital  work- 
shops can  take  the  time,  and  such  a  course  may 
mean  a  partial  self-support  where  help  is 
greatly  needed. 

A  great  deal  of  combined  medical  and  in- 
dustrial observation  will  be  needed  before  the 
idea  of  hospital  industries  can  be  carried  out 
in  a  really  adequate  and  comprehensive  way. 
It  seems  reasonable,  however,  that  the  idea 
should  be  taken  up  by  the  proper  authorities 
in  the  larger  and  smaller  general  hospitals. 
The  way  has  been  shown  for  a  beginning  at 
least.  Occupation  for  the  handicapped  is  a 
fine  adventure — there  is  no  telling  what  it  may 
lead  to  along  clinical  or  economic  lines. 

If  there  were  no  other  justification  for  the 
work,  the  production  of  hope  and  courage 
under  adverse  conditions  would  be  enough. 
The  idea  is  one  of  enlarged  and  improved  so- 
cial service;  it  means  a  chance  for  the  handi- 
capped to  make  at  least  a  partial  living  when 
other  opportunity  is  denied.  This  is  the  very 


WORKSHOP  IN  GENERAL  HOSPITALS  11 

root  of  Social  Service.  No  amount  of  kindly 
advice  and  social  or  hygienic  uplift  can  ever 
take  its  place.  There  is  a  fair  chance  of 
reaching  the  moral  and  social  needs  of  a  man 
after  he  is  given  work  to  do — while  he  is  idle 
his  various  needs  can  be  reached  only  with 
great  difficulty. 

Hospital  authorities  who  may  object  to 
such  enterprises  need  only  be  shown  that  work 
for  handicapped  people  is  of  definite  medical 
value.  The  new  workshops  may  well  be 
recognized  as  legitimate  clinical  departments 
of  any  charitable  hospital.  One  has  only  to 
see  the  discouraged  and  depressed  paralytic 
take  heart  or  the  incurable  grow  happy  and 
contented  under  this  system  to  be  convinced 
of  its  medical  value. 


II 

MANUAL  WORK  FOR  PATIENTS  IN  STATE 
AND  COUNTY  HOSPITALS 

THE  practice  of  medicine  has  changed  in  no 
way  more  remarkably  than  in  the  new  respon- 
sibility it  assumes  for  the  social  and  moral 
welfare  of  its  patients.  We  need  no  longer 
call  attention  to  the  need  of  social  service  in 
connection  with  hospital  and  dispensary  work 
— it  is  an  established  thing.  That  the  charita- 
ble institution,  and  especially  the  state  hospital, 
should  concern  itself  seriously  with  the  matter 
of  carefully  specialized  work  for  its  patients 
both  in  and  out  of  the  hospital  is  a  newer  con- 
ception that  merits  careful  attention. 

When  work  is  proposed  for  a  sick  man  in 
hospital  or  out,  the  first  thought  is  a  revulsion. 
It  would  seem  that  the  sick  might  be  left  in 
peace  to  recover  at  leisure.  But  we  are  not 
thinking  of  the  acute  and  more  painful  ill- 
nesses in  which  work  is  impossible.  There  are 
thousands  of  people  in  the  state  and  county 

12 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      13 

hospitals  who  cannot  ordinarily  be  depended 
upon  for  intelligent  work,  but  who  have  ca- 
pacities that  are  being  developed  with  no  in- 
considerable profit  to  everybody  concerned. 
To  say  nothing  of  the  economic  possibilities, 
work  is  almost  a  moral  necessity.  It  is  essen- 
tially an  expression  of  good-will  and  common 
service  that  helps  to  keep  life  wholesome. 
Even  if  it  does  not  mean  much  money  return 
it  can  always  bring  some  degree  of  self-re- 
spect. There  need  be  no  quarrel  with  diver- 
sion and  amusement,  but  there  comes  a  time 
when  these  things  pall  and  there  is  need  of 
real  employment.  It  is  no  new  thing  for  the 
chronic  patients  in  the  state  and  county  hospi- 
tals to  be  given  work  to  do.  Such  action  has, 
however,  until  recently,  been  desultory,  and 
due  to  the  chance  initiative  of  individual  su- 
perintendents. There  is  growing  up  now  a 
new  science  of  work  which  will  not  be  satisfied 
with  the  demand  of  household  service  from 
those  who  are  most  able.  The  -new  science 
will  study  the  possibilities  and  the  effect  of 
productive  work  upon  each  patient,  and  it  will 
require  measured  work  for  therapeutic  as  well 
as  economic  reasons. 


14  THE  WORK  OF  OUR  HANDS 

There  are  many  state  hospitals  where  to- 
day a  great  deal  of  useful  house  or  ward  work 
is  done  by  the  inmates.  Here  and  there  may 
be  found  well-equipped  workshops.  The  cut- 
ting and  making  of  clothing  for  the  patient's 
own  use  is  one  of  the  best  outlets  for  unused 
energy.  Through  the  installation  of  knitting 
machines  it  has  become  possible  for  patients  to 
make  such  things  as  stockings,  sweaters,  mit- 
tens and  caps  in  great  quantities.  These 
products  represent  real  money  value.  Among 
the  occupations  already  found  useful  for  the 
insane  and  feeble-minded  are  brush-  and 
broom-making,  cane-seating,  rug-making,  and 
the  hand-weaving  of  many  fabrics,  printing 
for  institutional  use,  lace-making,  cabinet- 
making  and  shoe  repairing.  These  things  are 
all  done  well  by  the  people  who  would  ordi- 
narily be  considered  useless  members  of  so- 
ciety. The  only  difference  is  that  a  great  deal 
of  time  is  consumed  and  especial  conditions  of 
oversight  and  system  must  be  maintained. 
The  work  is  professional  in  the  best  sense.  It 
is  rare  to  find  poor  craftsmanship.  More- 
over, here  is  a  valuable  means  of  treatment, 
most  potent  toward  creating  efficiency  and  the 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      15 

restoration  of  disordered  functions,  a  valuable 
means  of  treatment  that  should  cost  nothing. 
Here  is  a  medical  agent  of  the  first  quality 
which  may  actually  save  the  State  large  sums 
of  money.  It  is  true  that  many  institutional 
superintendents  do  not  know  how  much 
money  is  saved  by  the  occupation  of  patients. 
One  of  the  best  managers  in  the  country  con- 
fessed to  the  writer  that  the  repairs  on  boots 
and  shoes  done  in  his  workshops  would  cost 
the  institution  in  excess  of  $5,000  annually  if 
done  by  outside  help.  He  did  not,  however, 
publish  that  amount  or  other  much  larger  sav- 
ings in  the  various  departments  because  he 
was  afraid  that  the  politicians  and  perhaps  the 
friends  and  relatives  of  the  patients  would 
look  upon  the  matter  as  an  exploitation  of 
helpless  inmates  and  so  put  a  stop  to  all  work. 
In  this  shoe-repairing  shop  where  the  foot- 
wear of  twelve  hundred  people  is  kept  in  re- 
pair, a  long  row  of  happy  boys  with  their 
mouths  full  of  brads,  hammers  out  a  cobbler's 
chorus  that  answers  all  the  objection  of  ig- 
norance. 

The  employment  of  the  insane  in  the  ward 
and  house  work  of  the  institutions  is  a  long 


16  THE  WORK  OF  OUR  HANDS 

established  custom.  A  great  deal  of  money  is 
saved  this  way  that  would  otherwise  be  spent 
for  service.  This  is  undoubtedly  the  oldest 
form  of  occupation  for  the  insane.  Under 
careful  restriction  it  is  wise  and  legitimate. 
But  no  kind  of  occupation  is  so  liable  to  abuse 
or  so  difficult  to  apply  scientifically.  Dr.  Eva 
C.  Reid  of  San  Francisco  in  a  recent  article 
on  "Ergotherapy  in  the  Treatment  of  Mental 
Disorders"  *  says  of  the  female  patient:  "If 
she  shows  an  inclination  to  work  she  is  given 
a  trial  in  the  laundry,  sewing-  or  dining-room 
of  the  institution.  If  she  proves  careless  or 
inefficient  in  her  work,  she  is  sent  back  to  the 
ward.  Because  she  allowed  an  'iron  to  burn 
out,'  spoiled  a  garment  in  the  making,  or 
broke  a  few  dishes,  many  a  poor  soul  has  been 
condemned  to  perpetual  idleness,  for  the  re- 
mainder of  her  life.  .  .  .  On  the  other  hand  if 
a  patient  proves  to  be  a  willing  and  efficient 
worker,  she  is  condemned  to  a  life  of  hard 
labor.  In  every  state  institution  we  find  old 
demented  patients  whose  life  has  become  an 
existence  of  hopeless  drudgery  with  no  time 
allowed  for  recreation  or  diversion." 

*  Boston  Medical  and  Surgical  Journal,  August  20,  1914. 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      17 

Such  a  conception  of  work  for  the  insane  is 
not  much  longer  to  be  tolerated.  There  must 
be  no  routine  employment  without  the  most 
careful  consideration  of  the  medical  and  social 
needs  of  the  patient.  If  these  needs  can  be 
met  by  carefully  planned  house  and  ward 
service — well  and  good — otherwise  that  work 
must  be  done  by  hired  help,  and  the  difference 
made  up  in  some  other  department  of  labor. 

Farming  and  gardening  present  themselves 
as  primitively  possible.  As  a  matter  of  fact 
these  pursuits  have  been  carried  on  for  a  good 
many  years  with  great  success  in  many  insti- 
tutions. Naturally,  better  farming  is  done 
when  the  work  is  in  the  hands  of  able-bodied 
and  experienced  men,  but  there  is  an  enor- 
mous amount  of  routine  that  can  be  done  per- 
fectly well  by  the  handicapped  when  there  is 
steady  and  careful  supervision.  Among  the 
feeble-minded  and  the  insane  such  work  has 
its  largest  development.  Ordinarily  the  boys 
and  men  farm  in  small  gangs  under  the  direc- 
tion of  competent  foremen.  These  foremen 
are  sometimes  professional  farmers,  but  often 
enough  they  are  old  patients  who  have  be- 
come competent.  The  asylums  report  excel- 


18  THE  WORK  OF  OUR  HANDS 

lent  work  and  splendid  financial  returns  and 
they  also  report  mental  and  bodily  improve- 
ment, less  restlessness  and  violence  among  pa- 
tients otherwise  inclined  to  be  difficult.  Here 
is  fine  healthful  work.  Every  stroke  of  the 
shovel  and  hoe  that  does  not  overtax  the 
strength  is  clear  gain  to  the  patient,  and  to 
the  commonwealth.  The  idle  farm  and  the 
idle  patient  seem  existing  for  each  other.  The 
time  has  come  when  economy  and  therapeutics 
both  demand  the  raising  of  crops,  road-mak- 
ing, the  grading  and  draining  of  land. 

It  is  a  question  whether  it  is  wise  for  state 
hospitals  to  engage  in  the  manufacture  of  ar- 
ticles to  be  sold  outside  in  the  open  market. 
This  is  done  sometimes  and  with  apparent  ad- 
vantage. In  one  large  New  England  city, 
where  there  is  a  state  hospital,  the  local  trade 
is  supplied  with  brooms  and  brushes  made  in 
the  hospital.  Certainly  it  is  wise  to  manufac- 
ture articles  which  can  be  used  in  the  hospital 
where  they  are  made  or  in  other  state  institu- 
tions. 

The  matter  of  reward  in  return  for  industry 
is  still  open  for  discussion.  It  seems  only  fair 
that  direct  money  returns  should  be  made  to 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      19 

the  patients  or  their  families.  In  some  cases 
extra  freedom,  especial  diet,  etc.,  will  be 
enough.  Beyond  a  fair  return  to  the  worker 
or  his  family  money  saving  should  be  largely 
returned  to  the  State  that  it  may  diminish  in 
some  degree  the  increasing  burden  of  support. 

There  are  great  possibilities  of  the  reciproc- 
ity between  institutions.  One  hospital  might 
well  specialize  in  some  line,  such  as  the  making 
of  socks  and  stockings.  In  this  way  high  skill 
could  be  acquired  and  a  large  and  desirable 
output  be  maintained  for  the  supply  of  an  in- 
creasing chain  of  institutions. 

If  we  bear  in  mind  two  essentials,  that  the 
patient  must  be  benefited  physically  and 
mentally  by  the  work  and  that  the  product 
must  be  first  class  in  every  respect,  we  shall 
not  go  far  astray,  and  we  shall  begin  to  reach 
the  financial  gain  as  well  as  the  clinical  ad- 
vantages of  the  new  system. 

Already  such  beneficent  occupation  is  the 
rule  rather  than  the  exception;  The  great 
need  now  is  of  system  and  classification.  We 
must  know  surely  what  classes  of  cases  react 
best  to  given  kinds  of  work  and  we  must  make 
common  knowledge  of  the  difficulties  and  sue- 


20  THE  WORK  OF  OUR  HANDS 

cesses  of  institutional  occupations  all  over  the 
world.  This  much  is  certain,  that  there  are 
vast  sources  of  productive  power  lying  unnec- 
essarily idle  in  the  state  institutions  for  the  in- 
sane. State  hospital  superintendents  agree 
that  much  useful  work  is  possible,  that  it  may 
represent  large  savings  to  the  State  and  that 
productive  occupation  is  welcomed  by  patients 
of  all  classes. 

In  the  prisons  of  most  States  productive  oc- 
cupations occupy  a  foremost  place — adequate 
systems  of  exchange  of  commodities  have  been 
established  between  institutions  and  an  im- 
mense saving  is  made  for  the  State.  No  one 
doubts  the  advantage  to  the  prisoners.  Our 
insane  and  feeble-minded  are  prisoners  in  the 
larger  and  better  sense,  they  are  restrained  for 
the  safety  of  the  community  and  for  their  own 
advancement.  It  would  seem  that  there  is  no 
good  reason  why  these  mental  "prisoners" 
should  be  denied  the  advantages  offered  to 
criminals. 

A  series  of  questions  sent  recently  to  super- 
intendents of  state  hospitals  throughout  the 
country  brought  most  interesting  answers. 
The  questions  were  as  follows: 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      21 

1.  What  work  is  being  done  by  insane  or 
feeble-minded  patients  in  your  hospital? 

2.  What  is  the  effect,  generally  speaking, 
upon: 

A.  The  excited  cases, 

B.  The  depressed  cases, 

C.  The  feeble-minded  cases? 

3.  Does  the  work  of  your  patients  represent 
a  definite  saving  in  money  to  the  institution? 
Is  this  saving  great  or  small? 

Almost  without  exception  the  answers  were 
enthusiastic  in  regard  to  the  value  of  occupa- 
tion for  patients  of  all  classes,  and  with  very 
few  exceptions  the  saving  to  the  institution 
was  considerable. 

Extracts  from  some  of  the  letters  follow: 

EASTERN  STATE  HOSPITAL, 

WlLLIAMSBURG,   VA. 

G.  W.  BROWN,  M.D.,  SUPERINTENDENT 
In  answer  to  Question  1  will  state  that  a  large 
number  of  our  men  work  on  our  farm  and  garden; 
about  the  yards  and  grounds.  Some  of  them  work 
at  carpenter's  trade,  some  in  the  shoe  shop,  baker's 
shop,  tailor  shop,  some  in  the  chair  and  mattress  fac- 
tory, some  in  the  kitchen  and  of  course  a  great  many 
of  them  do  janitor  work.  We  are  now  erecting  a  new 
Infirmary  and  a  great  many  of  our  male  patients 


22  THE  WORK  OF  OUR  HANDS 

who  are  able  bodied  (70  per  cent.)  do  some  kind  of 
work.  All  the  clothing  for  the  patients  is  made  at 
the  Institution  both  for  men  and  women.  A  great 
many  of  them  do  fancy  work  and  we  have  a  special 
instructress  who  makes  an  effort  to  retrain  our 
dementia  praecox  cases  and  some  of  the  dements. 
This  is  in  needle  work,  fancy  work,  and  rug  weav- 
ing. 

In  answer  to  Question  %  will  state  that  a  great 
many  of  all  classes  are  improved ;  however,  we  do  not 
work  our  acutely  excited  cases.  We  generally  keep 
these  on  the  ward  and  give  them  hydrotherapeutic 
treatment  until  they  become  tractible;  after  which 
time  we  make  an  effort  to  get  them  out  on  the  farm 
and  yards  and  give  them  outside  employment  until 
they  become  more  quiet. 

In  answer  to  Question  3  will  say  that  we  have  no 
definite  figures  which  we  can  give  you.  I  am  certain 
that  this  labor  is  quite  a  saving  to  the  Institution. 
I  figure  that  it  reduces  our  wage  scale  about  one-half. 


VERMONT  STATE  HOSPITAL 

WATERBURY,  VERMONT 
DON.  D.  GROUT,  M.D.,  SUPERINTENDENT 
The  effect  upon  all  classes  of  having  what  work 
they  are  capable  of  doing  is  beneficial  in  every  way. 
The  work  of  the  patients  is  profitable  in  every  way ; 
it  lessens  our  per  capita  cost  of  maintenance  very 
materially,  probably  fifty  per  cent. 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      23 

TOPEKA  STATE  HOSPITAL 

TOPEKA,  KANSAS 
T.  C.   BIDDLE,  M.D.,  SUPERINTENDENT 

Aside  from  the  farm  and  garden  work,  I  have,  in 
recent  years,  been  doing  much  of  our  construction 
with  patient  labor.  The  insane  under  supervision 
of  one  or  two  competent  constructionists  can  be  em- 
ployed successfully  in  any  kind  of  building  enterprise, 
especially  concrete  construction. 

Throughout  the  two  years  we  have  been  able  to 
supply  our  male  patients  with  a  large  amount  of  con- 
genial employment.  The  usual  request  of  our  pa- 
tients is  to  be  allowed  to  go  out  with  the  working 
parties  and  an  opportunity  to  engage  in  some  use- 
ful exercise.  We  find  no  remedial  agent  that  affords 
more  positive  results  in  restoring  the  mental  balance 
of  our  cases.  Unfortunately,  we  find  greater  diffi- 
culty in  providing  suitable  occupation  for  our  female 
inmates.  This  can  best  be  provided  by  establishing 
a  crafts  and  art  department,  under  the  direction  of  a 
competent  instructor.  It  is  a  well  established  fact 
that  much  can  be  done  in  stimulating  recovery  in  cur- 
able cases  through  useful  occupation. 


STATE  OF  NEW  YORK,  CENTRAL  ISLIP  HOSPITAL 
G.  A.  SMITH,  M.D.,  SUPERINTENDENT 

We  have  found  the  effect  of  diversional  and  other 
occupations  more  beneficial  than  any  other  one 
therapeutic  agent.  This  applies  to  substantially  all 
cases  except  the  delirious.  Eor  the  latter  class  we, 


24  THE  WORK  OF  OUR  HANDS 

of    course,    pin    our    faith    largely    on    the    several 
hydrotherapeutic  agents. 

While  the  labor  of  our  patients  represents  a 
definite  saving  in  dollars  and  cents,  we  regard  that  as 
nothing  when  the  beneficial  effects  on  the  mental  and 
physical  condition  of  the  individual  patient  is  taken 
into  consideration. 


BOSTON  STATE  HOSPITAI>, 

DORCHESTER  CENTRE,  MASS. 

H.  N.  FROST,  M.D.,  SUPERINTENDENT 

1.  The  enclosed  list  of  patients'  occupations,  out- 
side of  hospital  routine  work,  shows  in  more  detail 
what  our  patients  are  doing. 

2.  The  effect  of  this  industrial  activity,  generally 
speaking,  is  decidedly  favorable,  diminishing  excite- 
ment, stimulating  those  who  are  depressed  and  in- 
active, and  putting  some  degree  of  efficiency  into  the 
feeble-minded. 

3.  The  work   of  our  patients   represents    a   con- 
siderable saving  in  money,  which,  however,  I  am  not 
able  to  give  in  figures  at  this  time. 

Patients9  Industries 

Women:  Sewing,  mending,  embroidery,  crochet- 
ing, lace  making,  tatting,  weaving,  spinning,  rug  mak- 
ing, basketry,  straw  braiding,  hat  making,  knitting, 
raveling,  stenciling,  kindergarten  work,  paper  work, 
bead  work. 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      25 

Men:  Mattress  making,  upholstery,  furniture  re- 
pairing, chair  caning,  basketry,  straw  hat  manufac- 
ture, mat  making,  rug  making,  weaving,  stocking 
knitting  (machine),  broom  making,  cement  and  clay 
modeling,  metal  work,  leather  work,  wood  carving, 
cabinet  making,  picture  framing,  book  binding,  etc. 

Dr.  George  Kline  of  the  Danvers  (Massa- 
chusetts) State  Hospital  reports  a  saving  of 
about  $1400  a  year  on  one  item,  the  making  of 
soap  from  the  waste  fats  of  the  institution. 
The  men  who  do  this  work  enjoy  it  and  take 
great  pride  in  their  product. 

A  general  idea  of  the  extent  of  State  Hos- 
pital occupation  in  Massachusetts  may  be  ob- 
tained from  the  following  table  published  in 
Bulletin  No.  7  of  the  Massachusetts  State 
Board  of  Insanity: 

Occupations  and  Industries 

Herewith  is  presented  a  report  of  a  survey  of  occu- 
pations for  a  single  day  at  each  of  the  State  institu- 
tions under  the  supervision  of  this  Board,  being  an 
average  day's  work,  showing  the  whole  number  of 
patients  at  each  hospital  on  that  day,  the  number 
employed,  those  unable  to  be  employed,  and  the  num- 
ber idle,  with  per  cents. 


THE  WORK  OF  OUR  HANDS 


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MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      27 

The  following  shows,  in  addition,  a  detailed  state' 

ment  of  tlie  work  at  each  hospital,  g'wing 

hours  of  employment,  etc.: 

Gardner  State  Colony 

Per  cent. 

Total  number  of  patients  in  hospital,       ....  740 

Total  number  of  patients  unable  to  work,  ...  24,  or   3.24 

Total  number  of  patients  employed,     ....  681,  or  92.03 
Total  number  of  patients  employed  for  less  than 

1  hour, 3,  or     .40 

Total  number  of  patients  employed  for  1  hour,  9,  or    1.23 


Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


40,  or  5.41 

38,  or  5.14 

49,  or  6.62 

51,  or  6.89 

30,  or  4.05 

55,  or  7.43 
406,  or  54.86 


681,  or  92.03 

Worcester  State  Hospital 

Per  cent. 

Total  number  of  patients  in  hospital,       ....  1,418 

Total  number  of  patients  unable  to  work,      .     .     .  110,  or   7.76 

Total  number  of  patients  employed, 1,273,  or  89.77 

Total  number  of  patients  employed  for  less  than 

1  hour, 167,  or  11.78 

Total  number  of  patients  employed  for  1  hour,  185,  or  13.05 


Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours,. 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


223,  or  15.73 

162,  or  11.42 
69,  or  4.87 
87,  or  6.13 

137,  or  9.66 
71,  or  5.01 

172,  or  12.12 

1,273,  or  89.77 


28 


THE  WORK  OF  OUR  HANDS 


Monson  State  Hospital 

Total  number  of  patients  in  hospital,        .     .     .     . 
Total  number  of  patients  unable  to  work,      .     .     . 

Total  number  of  patients  employed, 

Total  number  of  patients  in  school, 

Total  number  of  patients  employed  for  less  than 

1  hour, 

Total  number  of  patients  employed  for  1  hour, 
Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Per  cent. 
938 

103,  or  10.98 
787,  or  83.90 

40,  or   4.27 

7,  or  .75 

15,  or  1.60 

7,  or  .75 
52,  or  5.54 
11,  or  1.17 

687,  or  73.24 

8,  or     .85 
787,  or  83.90 


Medfield  State  Hospital 


Total  number  of  patients  in  hospital,        .... 
Total  number  of  patients  unable  to  work, 

Total  number  of  patients  employed, 

Total  number  of  patients  employed  for  less  than 

1  hour, 

Total  number  of  patients  employed  for  1  hour, 
Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Per  cent. 
1,630 

226,  or  13.86 
1,326,  or  81.35 

164,  or  10.06 

149,  or   9.14 

171,  or  10.49 

199,  or  12.21 

210,  or  12.88 

169,  or  10.37 

157,  or   9.63 

52,  or    3.19 

55,  or   3.38 

1,326,  or  81.35 


Worcester  State  Asylum 

Per  cent. 

Total  number  of  patients  in  hospital,       ....  1,391 
Total  number  of  patients  unable  to  work,      .     .     .        96,  or   6.90 
Total  number  of  patients  employed,        ....  1,094,  or  78.65 
Total  number  of  patients  employed  for  less  than 

1  hour, 39,  or   2.80 

Total  number  of  patients  employed  for  1  hour,        .      165,  or  11.86 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS 


Worcester  State  Asylum — continued 


Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Per  cent. 

77,  or  5.54 
11 9,  or  8.56 
231,  or  16.61 

79,  or  5.68 
156,  or  11.21 
129,  or  9.27 

99,  or    7.12 


1,094,  or  78.65 


Taunton  State  Hospital 

Total  number  of  patients  in  hospital,       .     .     .     . 
Total  number  of  patients  unable  to  work,      .     .     . 

Total  number  of  patients  employed, 

Total  number  of  patients  employed  for  less  than 

1  hour, 

Total  number  of  patients  employed  for  1  hour, 
Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Per  cent. 
1,263 

203,  or  16.07 
899,  or  71.18 

39,  or  3.09 

54,  or  4.28 
112,  or  8.87 
286,  or  22.64 
114,  or  9.03 

17,  or    1.34 

255,  or  20.19 

1,  or     .08 

21,  or    1.66 

899,  or  71.18 


Westborour/h  State  Hospital 

Per  cent. 

Total  number  of  patients  in  hospital,       ....  1,211 

Total  number  of  patients  unable  to  work,      .     .     .  143,  or  11.81 

Total  number  of  patients  employed, 855,  or  70.60 

Total  number  of  patients  employed  for  less  than 

1  hour, '.     .  252,  or  20.81 

Total  number  of  patients  employed  for  1  hour,       .  108,  or   8.92 

Total  number  of  patients  employed  for  2  hours,      .  74,  or   6.11 

Total  number  of  patients  employed  for  3  hours,      .  61,  or   5.04 

Total  number  of  patients  employed  for  4  hours,       .  18,  or    1.48 

Total  number  of  patients  employed  for  5  hours,      .  1,  or     .08 

Total  number  of  patients  employed  for  6  hours,      .  341,  or  28.16 


855,  or  70.60 


30 


THE  WORK  OF  OUR  HANDS 


Danvers  State  Hospital 

Total  number  of  patients  in  hospital,       .     .     .     . 
Total  number  of  patients  unable  to  work, 

Total  number  of  patients  employed, 

Total  number  of  patients  employed  for  less  than 

1  hour, 

Total  number  of  patients  employed  for  1  hour, 
Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Per  cent. 
1,455 

294,  or  20.21 
901,  or  61.92 

16,  or    1.10 

59,  or  4.05 

167,  or  11.48 

156,  or  10.72 

112,  or   7.70 

105,  or    7.22 

203,  or  13.95 

25,  or    1.72 

58,  or   3.98 

901,  or  61.92 


Boston  State  Hospital 

Total  number  of  patients  in  hospital,       .... 
Total  number  of  patients  unable  to  work,      .     .      . 

Total  number  of  patients  employed, 

Total  number  of  patients  employed  for  less  than 

1  hour, 

Total  number  of  patients  employed  for  1  hour, 
Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Per  cent. 
1,421 

430,  or  30.26 
854,  or  60.10 

20,  or  1.48 
116,  or  8.16 

92,  or  6.47 
166,  or  11.61 

63,  or  4.43 
129,  or  9.08 
105,  or  7.39 
149,  or  10.49 

14,  or     .99 

854,  or  60.10 


Psychopathic  Department,  Boston  State  Hospital 

Per  cent. 

Total  number  of  patients  in  hospital,        ....        83 
Total  number  of  patients  unable  to  work,      ...        58,  or  69.88 
Total  number  of  patients  employed, 25,  or  30.12 


MANUAL  WORK  FOR  PATIENTS  IN  HOSPITALS      31 


Foxborough  State  Hospital 

Total  number  of  patients  in  hospital,       .     .     .     . 
Total  number  of  patients  unable  to  work,      .     .     . 

Total  number  of  patients  employed, 

Total  number  of  patients  employed  for  less  than 

1  hour, 

Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  8  hours, 


Northampton  State  Hospital 

Total  number  of  patients  in  hospital,       .     .     .     . 
Total  number  of  patients  unable  to  work, 

Total  number  of  patients  employed, 

Total  number  of  patients  employed  for  less  than 

1  hour, 

Total  number  of  patients  employed  for  1  hour, 
Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Mental  Wards,  State  Infirmary 

Total  number  of  patients  in  hospital,  .  .  . 
Total  number  of  patients  unable  to  work,  .  . 
Total  number  of  patients  employed,  .... 
Total  number  of  patients  employed  for  1  hour, 
Total  number  of  patients  employed  for  2  hours, 
Total  number  of  patients  employed  for  3  hours, 
Total  number  of  patients  employed  for  4  hours, 
Total  number  of  patients  employed  for  5  hours, 
Total  number  of  patients  employed  for  6  hours, 
Total  number  of  patients  employed  for  7  hours, 
Total  number  of  patients  employed  for  8  hours, 


Per  cent. 
284 

72,  or  25.36 
154,  or  54.22 

35,  or  12.32 

56,  or  19.72 
4,  or   1.41 
2,  or     .70 

57,  or  20.07 

154,  or  54.22 

Per  cent. 
883 

353,  or  39.98 
438,  or  49.60 

46,  or  5.22 
32,  or  3.62 
54,  or  6.11 
20,  or  2.26 
156,  or  17.67 

25,  or   2.83 
105,  or  11.89 


438,  or  49.60 

Per  cent. 

711 

127,  or  17.86 

348,  or  48.95 
18,  or  2.53 
22,  or  3.10 
26,  or  3.66 
47,  or  6.61 
17,  or  2.39 
29,  or  4.08 
84,  or  11.81 

105,  or  14.77 

348,  or  48.95 


32  THE  WORK  OF  OUR  HANDS 

Wrentham  State  School 

Per  cent. 

Total  number  of  patients  in  school, 640 

Total  number  of  patients  unable  to  work,     .     .     .        30,  or   4.69 
Total  number  of  patients  employed, 610,  or  95.31 

Massachusetts  School  for  the  Feeble-Minded 

Per  cent. 

Total  number  of  patients  in  school, 1,595 

Total  number  of  patients  unable  to  work,      .      .     .      420,  or  26.33 
Total  number  of  patients  employed, 1,175,  or  73.67 


Ill 


SANATORIUM  TREATMENT  FOR  PEOPLE  OF 
SMALL  MEANS 

MEN  and  women  of  small  means  or  none  are 
beset  with  conditions  especially  liable  to  break 
down  the  morale  and  to  precipitate  what  in 
more  prosperous  circumstances  is  called  nerv- 
ous exhaustion.  It  is  probably  true  that  the 
necessity  for  work  prevents  many  cases  of 
chronic  functional  illness,  but  privation  and 
anxiety  often  produce  serious  functional  dis- 
turbances. Mental  suffering  of  this  kind  is 
often  untreated  until  it  reaches  on  into  the 
more  serious  psychoses.  The  private  sana- 
toriums  take  care  of  the  situation  for  those  who 
can  pay,  but  must  stop  there.  Besides  the  dis- 
abled but  untreated  cases  of  nervous  exhaus- 
tion there  are  among  the  poor  all  of  the  recog- 
nized types  of  chronic  organic  diseases  of  the 
nervous  system.  At  present  there  are  very 
few  institutions  where  proper  medical  care  can 

33 


34  THE  WORK  OF  OUR  HANDS 

be  given  in  chronic  illness  of  any  kind.  There 
is,  as  a  matter  of  fact,  a  great  deal  besides 
medical  care  that  needs  to  be  managed  for 
these  people.  Most  of  the  functional  nervous 
cases  and  many  of  the  organic  disabilities  need 
the  occupation  which  is  denied  them  in  the  in- 
dustrial world.  Many  of  these  chronic  inva- 
lids could  partly  pay  for  their  treatment,  and 
most  of  them  by  working  under  favorable  con- 
ditions could  pay  something  toward  mainte- 
nance. 

The  present  chapter  will  consider  especially 
the  situation  with  reference  to  the  functional 
nervous  cases  that  are  not  cared  for  anywhere, 
because  the  more  evident  disabilities  are  always 
first  to  receive  attention.  Even  if  these  were 
definitely  charitable  cases  the  overcrowded 
hospitals  and  dispensaries  and  asylums  could 
not  give  the  right  kind  of  treatment.  Obvi- 
ously the  State  or  private  charity  cannot  hope 
to  supply  the  luxuries  of  the  high  priced  sana- 
toriums.  Yet  the  time  will  come  when  char- 
ity will  consider  especially  the  needs  of  the  pa- 
tient of  small  means  and  who  can  help  out  a  lit- 
tle in  the  cost  of  treatment.  Charity  after  all 
has  two  sides;  it  gives  for  humanity's  sake  and 


TREATMENT  FOR  PEOPLE  OF  SMALL  MEANS          35 

it  gives  because  it  actually  pays  to  put  the 
fallen  on  their  feet.  Accumulated  weight  of 
disability  in  time  rolls  back  upon  society  with 
destructive  force.  Idle  men  and  women  mean 
increased  taxation  and  widespread  suffering. 
Idleness,  moreover,  too  often  leads  along  the 
paths  of  violence  and  crime.  Inefficiency  in 
the  worker  is  a  great  industrial  menace — we 
cannot  forever  supply  the  demand  for  skilled 
labor  unless  we  do  something  to  restore  those 
who  have  broken  down  under  the  strain  of  com- 
petition and  the  stress  of  speed.  A  new  type 
of  sanatorium  will  have  to  be  invented — it  will 
be  neither  hospital  nor  asylum  and  it  must  ac- 
complish its  results,  without  much  expense  to 
the  community.  Such  a  sanatorium  seems  at 
last  possible  through  the  advent  of  the  work 
cure.  Work,  if  it  is  within  the  capacity  of 
the  so-called  nervous  patient,  is  often  helpful 
in  the  highest  degree.  It  is  one  of  the  reme- 
dial agents  that  intelligently  used  may  restore 
and  comfort  just  as  it  harms  when  it  is 
over-used  or  mis-used.  Work  as  a  remedy 
may  become  an  actual  pleasure  while  it  brings 
back  confidence  and  strength  and  renews 
wasted  nerve  and  muscle  tissue.  The  work 


36  THE  WORK  OF  OUR  HANDS 

cure  takes  the  weakened  individual  and  ex- 
amines him  critically  to  see  what  he  may  safely 
do  without  detriment  to  mind  or  body.  Then 
it  proceeds  to  supply  that  work  as  part  of  the 
cure.  Experience  already  shows  that  there  is 
no  good  reason  why  work  which  is  used  as  a 
remedy  should  not  be  made  to  yield  a  money 
return.  It  looks  very  much  as  though  work 
well  directed  and  under  favorable  conditions 
might  become  a  remedy  for  wornout  bodies 
and  minds,  and  as  though  it  might  at  the  same 
time  do  something  toward  meeting  the  neces- 
sary cost  of  treatment. 

Before  discussing  some  of  the  possibilities 
of  handicapped  labor  it  will  be  well  to  inquire 
a  little  into  the  nature  of  nervous  exhaustion. 
Nervous  exhaustion,  sometimes  called  neuras- 
thenia or  psychasthenia,  is  often  considered  to 
be  a  disease  when  it  is  really  a  symptom-com- 
plex of  widely  varying  underlying  causes. 
Comprehensive  definition  would  be  difficult, 
yet  every  one  knows  the  condition.  Nervous 
exhaustion  is  not  only  "the  great  American 
disease" ;  it  has  been  for  long  the  great  Ameri- 
can puzzle.  The  medical  world  has  finally 
come  to  agree  that  practically  every  case  of 


TREATMENT  FOR  PEOPLE  OF  SMALL  MEANS          37 

nervous  exhaustion  has  some  physical  weak- 
ness or  disability  behind  it  or  in  it.  There  are 
great  differences  in  individual  stamina  irre- 
spective of  physical  conditions,  but  with  a  reg- 
ularity that  is  more  and  more  apparent  it  is 
found  that  nervously  broken  down  people  are 
also  physically  weak — the  subjects  of  more  or 
less  evident  defects  or  disease.  Often  enough 
there  are  local  troubles  to  be  corrected  or 
ameliorated,  joint  affections,  broken  foot 
arches,  defective  vision,  poisoning  from  bad 
teeth  and  unhealthy  gums,  and  a  long  list  be- 
sides. When  the  body  is  in  constant  distress 
physical  fatigue  begets  mental  and  nervous 
fatigue  and  irritability.  We  see  the  familiar 
picture  of  the  "nervous  wreck,"  who  cannot 
sleep  or  eat  or  even  think  successfully.  No 
wonder  old  and  new  fears  and  doubts  come  in 
to  dominate  the  picture. 

Sometimes  it  happens  that  nervous  patients 
are  examined  most  carefully  by  competent 
medical  men  who  find  nothing  organically 
amiss.  That  otherwise  hopeful  finding  may 
have  most  unfortunate  results,  for  it  stamps 
the  patient  as  neurasthenic  and  makes  him  in 
the  eyes  of  the  world  at  least  to  blame  for  his 


38  THE  WORK  OF  OUR  HANDS 

inability  to  bear  the  burden  and  heat  of  the 
day.  A  very  large  proportion  of  the  nerv- 
ous breakdowns  without  apparent  cause  are 
now  known  to  be  associated  with  the  condition 
called  enteroptosis,  in  which  the  whole  body 
droops  from  muscular  fatigue  and  from  a  cer- 
tain congenital  or  acquired  laxity  and  physical 
unbalance.  All  the  internal  organs,  but  es- 
pecially the  stomach  and  intestines,  share  in 
the  failure  of  tone.  As  a  result  of  the  bodily 
drooping  we  have  some  of  the  most  distressing 
forms  of  indigestion,  some  of  the  most  in- 
tractable cases  of  circulatory  and  nervous  dis- 
turbance. Some  day  it  will  be  more  generally 
understood  that  cramped  and  relaxed  bodies 
are  a  menace,  that  they  shut  up  the  vital  or- 
gans in  very  narrow  and  unwholesome  quar- 
ters. It  may  be  shown  that  even  organic  as 
well  as  functional  disease  can  come  about 
through  such  interference  with  circulation  and 
nerve  supply.  Corrections  of  posture,  the 
clearing  up  of  old  infections,  the  improvement 
of  muscular  and  ligamentous  tone — all  these 
are  slow  processes  requiring  not  only  time  but 
the  constant  cooperation  of  trained  workers. 
We  must  look  to  sanatoriums  of  some  sort  for 


TREATMENT  FOR  PEOPLE  OF  SMALL  MEANS         39 

the  necessary  patience  and  equipment.  Real 
cure,  moreover,  is  usually  not  confined  to  phys- 
ical improvements.  There  must  be  hope  and 
courage,  there  must  be  a  conception  of  life  fine 
enough  and  big  enough  to  bridge  all  gaps  with 
sufficient  faith  and  understanding.  There 
must  be  a  wholesale  clearing  away  of  old  and 
hampering  misconceptions,  a  lightening  of 
fears  and  other  mental  burdens.  These  es- 
sentials also  require  much  time  for  their  com- 
ing and  their  coming  is  more  likely  under  such 
conditions  as  the  sanatoriums  can  afford.  The 
usual  treatment  at  home  does  not  get  at  the 
bottom  of  things.  Too  frequently  it  leaves 
untouched  some  of  the  great  fundamental  re- 
quirements. Without  new  training  in  life  and 
work,  treatment  can  not  bring  self-respect  and 
self-confidence.  In  a  surprising  number  of 
cases  of  nervous  exhaustion,  work,  under  fa- 
vorable conditions,  will  do  this  essential  thing. 
For  rich  or  poor  the  market  value  of  effort 
is  deep  and  significant.  Without  it  there  is  a 
sense  of  futility  which  is  deadly.  So  it  hap- 
pens that  productive  work  may  become,  not 
only  gymnastic  and  so  physically  restorative, 
but  morally  strengthening  as  well.  Within 


40  THE  WORK  OF  OUR  HANDS 

the  writer's  observation  a  man  has  loosened  up 
the  stiffened  joints  of  an  old  and  obstinate 
rheumatic  affection  by  the  use  of  interesting 
physical  work  after  massage  and  electricity, 
hydrotherapy  and  mechanotherapy  had  ut-, 
terly  failed.  At  the  same  time  he  cast  off  a 
despondency  that  philosophy  and  religion  it- 
self had  failed  to  lighten.  From  being  help- 
less and  hopeless  he  became  independent  and 
happy.  This  is  an  example  of  the  work  cure 
at  its  best.  If  such  a  thing  can  be  done  for 
one  man,  it  can  be  done  in  varying  degrees  for 
many. 

Sometimes  a  patient  who  is  nervously 
broken  down  has  as  the  chief  symptom  a  fa- 
tigue that  almost  precludes  work  of  any  kind. 
Very  likely  the  patient  does  not  know  he  can 
work,  or  is  so  alarmed  by  the  appearance  of 
fatigue  that  he  easily  gives  up.  Whether  such 
fatigue  is  physical  or  psychic,  in  hundreds  of 
cases  it  is  possible  to  bring  about  efficiency  by 
gradually  increasing  the  effort.  This  cannot 
be  done  carelessly  or  quickly;  it  is  a  problem 
for  experience  and  skill,  a  task  for  the  new 
sanatorium. 

There  are  ample  justifications  for  the  work 


TREATMENT  FOR  PEOPLE  OF  SMALL  MEANS          41 

cure  even  if  it  is  only  a  background  for  ade- 
quate medical  and  surgical  treatment,  even 
when  it  does  not  rise  to  the  dignity  of  a  posi- 
tive cure  in  itself. 

The  idea  of  the  work  cure  is  not  new  except 
in  its  systematic  application  under  institu- 
tional management.  It  has  always  been  real- 
ized that  work  may  be  curative,  that  it  may 
reorganize  and  regenerate  lives  that  have  long 
been  idle.  There  is  danger,  perhaps,  that  the 
matter  may  be  overdone  by  indiscriminate  ap- 
plication, and  that  cruel  injustice  may  be  vis- 
ited upon  people  who  actually  cannot  work. 
The  field,  however,  is  a  very  large  one  and  it 
does  not  stop  with  the  treatment  of  nervous 
exhaustion.  There  are  thousands  of  people  in 
the  cities  partly  disabled  by  accident  or  dis- 
ease, able  to  work  part  of  the  time  or  under 
favorable  conditions,  but  who  can  find  no  place 
in  the  regular  industrial  systems  because  they 
are  not  fully  efficient.  The  time  will  come 
when  practical  industries  will  be  conducted  in 
connection  with  sanatoriums  or  hospitals,  in- 
dustries which  will  give  these  people  their 
chance. 

It  is  amazing  what  skill  and  expedition  can 


42  THE  WORK  OF  OUR  HANDS 

be  acquired  by  many  severely  handicapped 
workers.  The  reason  is  not  far  to  seek.  They 
are  often  trained  people,  used  to  harder  work, 
to  the  fine  manual  dexterity  acquired  in  their 
regular  occupations. 

The  sanatorium  shop  and  the  general  hos- 
pital shop  have  one  and  the  same  ends  except 
that  the  sanatoriums  should  be  able  to  care  es- 
pecially for  nerve  and  chronic  cases,  and  for 
a  longer  time.  Both  institutions  can  be  made 
to  serve  a  large  class  of  people  too  sick  to  work 
in  regular  industries,  but  able  to  go  to  these 
special  shops  daily.  The  hospital  shop  is  very 
desirable  because  it  may  keep  families  together 
and  save  the  heavy  cost  of  the  maintenance  of 
beds  in  an  institution.  But  there  must  some- 
time be  regular  housing  facilities  for  handi- 
capped people,  especially  the  nervously  dis- 
abled, because  they  will  so  often  need  treat- 
ment that  cannot  be  carried  out  at  home. 
These  sanatoriums — for  such  they  must  be — 
will  have  as  their  aim  the  restoration  of  the 
sick  to  regular  wage  earning  possibilities,  but 
in  many  instances  they  must  themselves  main- 
tain specialized  industries. 

It  would  be  very  desirable  to  have  some- 


CEMENT    FLOWER    POTS    MADE    FROM    DEVEREUX 
MANSION  DESIGNS. 


TREATMENT  FOR  PEOPLE  OF  SMALL  MEANS          43 

where  a  well-equipped  and  endowed  experi- 
mental plant  where  various  industries  could  be 
tried  out,  modified,  and  adapted  to  new  uses. 
There  could  be  no  better  opportunity  for  pri- 
vate charity  than  the  establishment  of  such 
an  experimental  plant.  The  "station"  could 
study  the  field  in  a  large  way — not  only  devel- 
oping new  industries,  but  transferring  patients 
from  one  institution  to  another  so  that  condi- 
tions might  be  found  to  suit  the  especial  indus- 
trial capacity  of  the  individual.  It  is  said  that 
few  men  are  doing  the  work  for  which  they 
are  best  fitted.  Under  a  system  of  handi- 
capped labor  it  might  at  last  be  possible  to  fit 
the  work  to  the  man.  It  is  not  inconceivable 
that  in  this  way  a  partial  disablement  might 
actually  increase  a  man's  earning  capacity  as 
well  as  his  health  and  happiness. 

A  school  teacher  broke  down  in  her  work  a 
few  years  ago;  she  was  in  fact  never  fitted  for 
teaching.  As  a  part  of  the  treatment  of  her 
disability  she  learned  the  art  of  hand-weaving. 
She  is  now  earning  more  money  as  a  teacher 
of  weaving  than  she  did  as  a  teacher  in  the 
schools.  Incidentally  she  is  cured  of  nervous 
exhaustion. 


44  THE  WORK  OF  OUR  HANDS 

In  sanatoriums  situated  in  the  country, 
farming  would  prove  a  most  desirable  occu- 
pation, but  it  would  not  by  any  means  do  for 
all.  There  are  in  the  cities  great  numbers  of 
people  who  need  protected  occupation  but  who 
would  never  make  good  farmers.  They  are 
shop  workers,  city  dwellers  from  first  to  last; 
they  cannot  live  happily  and  successfully  in  the 
country.  For  the  benefit  of  such  people  the 
general  hospital  workshops  would  be  the  best, 
or  perhaps  sanatorium  workshops  in  the  city 
where  manufacturing  could  be  carried  on  un- 
der favorable  conditions. 

There  are  very  great  commercial  possibili- 
ties for  handicapped  labor.  If  the  handiwork 
of  great  numbers  of  half-time  people  can  be 
directed  and  coordinated  toward  an  adequate 
end,  the  results  will  be  surprising.  The  prob- 
able deficit  in  such  industries  need  not  be  a 
severe  tax  to  charity,  for  a  considerable  pro- 
portion of  the  patients  should  be  able  to  pay 
something  for  treatment.  In  this  way  it 
might  become  possible  for  people  of  small 
means  to  get  the  necessary  sanatorium  treat- 
ment without  paying  more  than  they  can  af- 
ford and  without  becoming  wholly  dependent 


TREATMENT  FOR  PEOPLE  OF  SMALL  MEANS          45 

upon  charity.  Any  one  who  is  acquainted 
with  sanatorium  work  knows  that  many  nerv- 
ous patients  possess  talents  and  abilities  of  a 
very  high  order.  Such  an  industrial  plan 
might  over  and  over  again  give  back  to  the 
world  rare  genius  and  ability  that  would  other- 
wise be  lost.  These  regenerations  can  come 
only  through  the  most  careful  medical  and  re- 
educational  treatment  such  as  only  well- 
equipped  hospitals  or  sanatoriums  can  afford. 


IV 

TEACHER  AND  PUPIL 

IF  invalid  occupations  are  to  be  carried  out  in 
a  large  way  there  will  be  need  of  a  good  many 
trained  people  to  conduct  and  to  supervise  the 
work.  This  should  be  a  new  and  desirable 
field  for  women.  The  business  will  have  to 
be  relatively  light  because  even  the  men  who 
work  will  be  too  much  disabled  for  very  stren- 
uous exertions.  What  sort  of  person  is  best 
fitted  to  perform  such  an  office  and  what  train- 
ing will  be  necessary?  Obviously  it  depends 
upon  the  direction  taken  by  the  new  indus- 
tries. If,  as  seems  likely  now,  the  ancient 
handicrafts  are  used  in  a  simplified  way,  do 
we  need  trained  craftsmen  for  teachers  or  can 
the  teaching  and  producing  be  done  by  the 
average  girl  who  graduates  from  school  or  col- 
lege? Experience  has  made  it  very  clear  to 
the  writer  that  the  trained  craftsman  is  often 
a  poor  teacher.  Probably  the  best  assistants 

46 


TEACHER  AND  PUPIE 

will  be  women  who  have  natural  teaching  abil- 
ity, who  would  do  well  in  the  schools.  The 
work  has  to  be  simplified  anyway  to  make  it 
available  for  the  handicapped  so  that  a  woman 
of  teaching  qualification  but  no  artistic  train- 
ing might  reasonably  do  very  well  after  the 
work  had  been  planned  and  developed  by  ex- 
perts. Somewhere  along  the  line  experts 
must  come  in,  but  as  a  rule  they  should  be  en- 
gaged in  experimental  work  and  in  the  teach- 
ing of  teachers  who  will  pass  on  the  necessary 
technique  to  the  invalid  pupils. 

The  shop  at  Marblehead  has  had  some  suc- 
cess in  training  partly  invalided  women  to  be 
teachers.  Although  dealing  for  the  most  part 
with  well-to-do  patients  this  shop  has  been  able 
to  take  at  reduced  rates  a  number  of  young 
women  who  had  broken  down  nervously  but 
who  were  recovering.  The  idea  has  been  to 
make  teachers  or  assistants  by  training  these 
women  in  various  kinds  of  modified  labor. 
The  plan  has  been  a  success,  generally  speak- 
ing, although  the  experience  of  putting  respon- 
sibility onto  the  shoulders  of  invalids  has  often 
been  a  trying  one,  both  to  the  invalids  and  to 
the  director. 


48  THE  WORK  OF  OUR  HANDS 

Suppose  light  blacksmithing  were  to  be  used 
as  an  invalid  occupation.  (Absurd  as  it 
sounds,  it  is  quite  possible  to  use  this  trade. 
The  making  of  fire-irons  such  as  pokers  and 
tongs,  shovels  and  forks,  is  delightful  work.) 
It  should  be  possible  to  call  upon  a  trained  de- 
signer for  the  proportions  and  the  working 
drawings.  Then  there  must  be  an  experienced 
blacksmith  who  will  at  once  go  about  the  ac- 
tual making  of  the  desired  articles.  This  man, 
though  presumably  a  good  workman,  will 
rarely  be  a  good  teacher.  In  working  out 
the  plan  he  should  have  an  apprentice  who 
has  the  teaching  qualifications.  This  appren- 
tice will  learn  how  to  work  the  iron,  then  he  or 
she  will  take  on  a  pupil  of  the  invalid  class 
who  is  able  to  do  certain  detail  work  under 
close  supervision.  This  is  the  working  plan — 
a  designer  who  may  be  useful  in  other  depart- 
ments, a  craftsman  who  need  not  be  a  teacher 
but  who  can  train  an  apprentice  who  will  teach. 
In  this  way  the  pupils  get  their  instruction; 
they  learn  to  do  what  they  are  told  while  the 
trained  craftsman  is  at  liberty  to  go  on  with 
his  work,  producing  articles  which  serve  as  an 
example  and  which  help  to  support  the  system 


TEACHER  AND  PUPIL  49 

by  their  sale.  The  apprentice  teacher  should 
be  able  to  handle  a  considerable  number  of 
handicapped  pupils.  It  is  really  a  modified 
factory  system  in  which  the  invalid  is  the  op- 
erative while  the  craftsman  and  his  apprentice 
are  the  planners  and  directors.  The  work  may 
be  so  systematized  and  subdivided  that  the  fee- 
blest person  may  do  something  that  counts. 

Here  then  is  a  new  field  for  designers,  for 
craftsmen  and  for  men  and  women  who  are 
willing  to  teach  detail.  These  teachers  must 
have  patience  and  tact  to  be  successful,  the  de- 
signer and  the  craftsman  must  be  skillful  and 
above  all  there  must  be  competent  medical  su- 
pervision so  that  the  invalid  workers  may  not 
be  overtaxed,  and  that  they  may  realize  that 
the  work  is  doubly  valuable  as  a  money  earn- 
ing expedient  and  a  training  back  to  efficiency 
and  health. 

If  it  is  planned,  as  must  often  be  the  case  in 
the  charitable  institution,  to  make  only  such  ar- 
ticles as  can  be  used  in  the  households  and  up- 
keep of  the  hospitals,  the  teachers  may  possi- 
bly be  practical  workers  taken  from  the  regu- 
lar outside  industries.  The  chances  are,  how- 
ever, that  there  will  have  to  be  assistants  of  a 


SO  THE  WORK  OF  OUR  HANDS 

more  versatile  sort — the  kind  of  people  who 
can  deal  with  the  human  element  as  well  as  the 
mechanical  requirements.  Especially  trained 
nurses  may  some  day  meet  some  of  the  indus- 
trial requirements. 

Any  one  acquainted  with  the  living  condi- 
tions of  the  asylums  will  realize  that  the  work 
of  teaching  is  no  sinecure.  There  is  much  that 
is  disagreeable  and  even  revolting — the  girl 
ready  to  teach  sewing  in  a  city  day  school  is 
not  necessarily  prepared  to  meet  these  condi- 
tions. It  will  be  seen  at  once  that  there  should 
be  a  training  school  for  teachers — a  school 
where  the  proposed  teacher  may  be  brought 
gradually  in  contact  with  the  difficulties  of  the 
work.  Such  a  school  might  easily  be  estab- 
lished in  connection  with  any  state  hospital. 
Beyond  this,  the  teaching  is  essentially  a  mis- 
sionary work  and  requires  the  missionary 
spirit.  Such  schools  as  that  at  Northfield, 
Mass.,  where  the  atmosphere  is  of  service  and 
where  the  training  is  hard  and  practical,  might 
well  furnish  the  best  of  teaching  stock. 


THE  TRAINED  NURSE  AND  THE  WORK  CURE 

THE  average  nurse  graduating  from  our  best 
general  hospitals  is  notoriously  helpless  in  deal- 
ing with  the  shifty  and  uncertain  prob- 
lems of  the  neurasthenic  or  mental  patient. 
This  cannot  well  be  otherwise,  for  the  hospital 
has  little  to  do  with  such  cases.  As  a  matter 
of  fact  the  so-called  nervous  case  is  apt  to  be 
badly  bungled  even  by  experienced  physicians 
unless  some  definite  system  of  management  is 
applied.  If  we  forget  the  thousand  and  one 
symptoms  and  look  at  the  case  from  the  stand- 
point of  efficiency  we  shall  begin  to  bring  order 
out  of  chaos.  The  physical  cause  of  nervous 
breakdown  should  of  course  be  -corrected  if 
possible.  Then  there  remains  the  inefficiency, 
the  fear,  the  restlessness  and  depression. 
These  so-called  nervous  symptoms,  then,  con- 
stitute an  illness  in  themselves  which  may  be 


52  THE  WORK  OF  OUR  HANDS 

dealt  with  independently  and  often  with  excel- 
lent results.  Even  if  there  is  incurable  physi- 
cal handicap  life  may  often  be  made  useful 
and  happy  when  fear  and  relative  inefficiency 
are  taken  away.  We  are  too  apt  as  doctors 
and  nurses  to  think  that  because  a  man  has 
locomotor  ataxia  his  usefulness  and  happiness 
are  over.  "Make  him  comfortable"  is  the 
usual  idea.  Make  him  as  useful  as  possible  is 
a  far  better  idea,  because  in  making  him  useful 
you  are  quite  likely  to  take  away  hopelessness 
and  despair ;  and  because  you  may  even  relieve 
some  of  the  most  distressing  physical  symp- 
toms. 

The  long  and  patient  personal  dealing  with 
chronic  invalids  falls  to  the  trained  nurse  or 
attendant.  If  the  nurse  has  had  a  training 
that  helps  her  to  make  her  patient  efficient  she 
is  likely  to  be  of  the  greatest  possible  service. 
Of  course,  there  are  amusements  that  help  in 
chronic  cases,  but  in  the  long  run  some  useful 
occupations  will  be  of  far  greater  service.  For 
this  reason  the  hospital  workshops  may  in  time 
play  a  very  important  part  in  the  training  of 
nurses.  In  these  shops  the  nurse  may  deal  at 
first  hand  with  the  problem  of  efficiency  for  the 


THE  TRAINED  NURSE  AND  THE  WORK  CURE   53 

handicapped.  She  may  see  the  paralytic 
learning  to  use  a  knitting  machine  as  well  as 
an  able-bodied  operator.  She  will  see  the 
difficulties  to  be  overcome  and  will  help  to 
overcome  them.  The  hospital  workshop  will 
then  be  comparable  with  the  normal  school  for 
the  training  of  teachers — the  school  where  the 
teacher  learns  teaching  by  teaching. 

The  Teachers'  College  of  Columbia  Uni- 
versity is  starting  a  course  of  instruction  in  in- 
valid occupations  for  graduate  nurses.  There 
are  infinite  possibilities  for  such  a  school.  It 
may  be  that  the  hurry  of  the  general  hospital 
will  not  allow  time  for  the  undergraduate  to 
work  in  the  shops.  In  this  case  such  a  course 
as  that  at  Columbia  might  well  cooperate  with 
the  hospitals  in  giving  graduate  pupils  ade- 
quate time  as  apprentices  in  the  new  indus- 
tries. 

There  are,  of  course,  many  nurses  who  will 
specialize  in  surgery  for  instance,  and  these 
might  not  find  it  profitable  to  deal  with  invalid 
occupations.  So  the  work  training  may  have 
to  be  optional.  But  that  it  can  be  extremely 
useful  to  some,  there  is  no  doubt. 

It  is  true  that  nurses  taking  private  cases 


54  THE  WORK  OF  OUR  HANDS 

might  rarely  wish  to  find  real  work  for  their 
patients.  It  will  some  day  be  understood, 
however,  that  real  work  is  the  best  training  for 
the  efficiency  that  every  patient  needs  and  de- 
sires. There  will  be  opportunity  for  the  nurs- 
ing instinct  and  judgment  to  be  used  in  hold- 
ing back  those  who  are  too  eager  and  in  urging 
those  who  are  loath  to  exert  themselves.  There 
is  a  whole  profession  in  this  function  alone,  for 
the  nervous  invalid  is  prone  to  grasp  at  a  new 
idea,  to  try  it  feverishly  and  to  fail.  Failure 
is  the  rule  for  a  considerable  time.  Patients 
must  be  taught  that  the  first  step  is  to  adapt 
the  occupation  and  the  whole  life  to  the  exist- 
ing limitations — to  do  this  not  grudgingly  but 
hopefully  and  thankfully.  This  means  get- 
ting a  footing.  This  first  foothold  will  some- 
times be  all  that  can  be  gained,  but  often,  after 
a  time,  indefinite  progress  usually  becomes  pos- 
sible. The  nurse  trained  in  the  efficiency  idea 
will  realize  that  too  rapid  progress  for  the  in- 
valid is  fatal  to  success.  She  will  understand 
that  much  happiness  and  general  improvement 
may  come  from  some  very  small  accomplish- 
ment. She  will  have  the  satisfaction  of  know- 
ing that  in  many  cases  she  will  have  the  chance 


THE  TRAINED  NURSE  AND  THE  WORK  CURE        55 

of  restoring  full  efficiency  and  happiness  where 
these  might  never  have  come. 

It  is  an  open  question  whether  the  appren- 
tice teacher  or  craftsman  in  the  hospital  or 
sanatorium  workshop  should  be  told  the  na- 
ture of  the  disease  with  which  she  deals  or  the 
intimate  history  of  the  patient.  Sometimes 
such  knowledge  would  be  of  decided  advantage 
to  both  parties.  On  the  other  hand  it  is  true 
that  without  a  great  deal  of  hospital  training 
medical  information  is  often  misunderstood 
and  misapplied.  There  are  undoubtedly  some 
industrial  teachers,  not  nurses,  who  can  make 
excellent  use  of  professional  knowledge.  As  a 
rule,  however,  the  physician  will  need  nurses 
to  help  him  out  in  dealing  with  the  whole  prob- 
lem. These  especially  trained  nurses  will 
form  an  important  link  in  the  new  industrial 
system.  They  will  have  the  confidence  of  the 
patients  and  the  physician,  teachers  and  crafts- 
men. In  many  instances  they  will  themselves 
be  the  best  teachers  to  serve  under  the  crafts- 
men. 

It  will  be  well  to  warn  here  against  a  ten- 
dency to  teach  nurses  a  smattering  of  a  few 
amusing  occupations — these  may  be  well 


56  THE  WORK  OF  OUR  HANDS 

enough  for  convalescent  children,  but  the  nurse 
to  be  well  equipped  industrially  must  go  into 
the  workshops  and  work  herself  side  by  side 
with  the  patients.  The  occupations  taught  to 
nurses  must  be  real  and  legitimate,  not  foolish 
"fancy  work." 


VI 

THE  WELL-TO-DO  PATIENT  AT  WORK 

IT  is  no  longer  a  strange  thing  for  doctors 
to  advise  work  as  a  remedy  for  people  who 
have  never  known  the  significance  of  manual 
occupations.  Many  people  are  nervously  ill 
because  their  lives  lack  purpose  and  dignity. 
The  rush  of  social  engagements,  the  stimula- 
tion of  travel,  the  search  for  amusement — 
these  things  may  satisfy  for  a  while,  but  they 
are  not  enough  to  last.  It  is  true  that  we 
would  not  always  wish  to  make  weavers  or 
potters  out  of  the  daughters  of  society.  But 
these  young  women,  when  they  go  to  pieces 
nervously,  do  so  sometimes  because  there  is  no 
depth  and  substance  in  their  lives.  There  is 
an  "aching  void"  that  is  not  filled,  especially 
when  they  fail  to  marry.  The  handicrafts  can 
hardly  fill  this  void,  but  when  the  nervous  in- 
valid gets  down  to  honest  work  with  her  hands 
she  makes  discoveries.  She  finds  her  way 

57 


58  THE  WORK  OF  OUR  HANDS 

along  new  pathways.  She  learns  something 
of  the  dignity  and  satisfaction  of  work  and 
gets  an  altogether  simpler  and  more  whole- 
some notion  of  living.  This  in  itself  is  good, 
but  better  still,  the  open  mind  is  apt  to  see  new 
visions,  new  hope  and  faith.  There  is  some- 
thing about  simple,  effective  work  with  the 
hands  that  makes  men  creators  in  a  very  real 
sense — makes  them  kin  with  the  great  creative 
forces  of  the  world.  From  such  a  basis  of 
dignity  and  simplicity  anything  is  possible. 
Many  a  poor  starved  nature  becomes  rich  and 
full.  All  this  is  aside  from  the  actual  physi- 
cal gains  that  may  come  from  new  muscular 
activities. 

The  tired  business  man  who  seeks  relaxation 
and  refreshment  by  running  through  Euro- 
pean capitals  is  apt  to  be  disappointed.  He 
will  sometimes  be  disappointed  when  he  does 
better  than  that  and  takes  the  course  at  Carls- 
bad or  Vichy.  He  is  still  dealing  with  too 
complex  and  highly  evolved  things.  For  real 
rest  his  mind  must  get  down  to  primitive  life. 
This  need  not  always  be  in  a  medical  work- 
shop, though  theoretically  that  should  be  the 
place.  Sometimes  a  walking  trip  or  a  shoot- 


THE  WELL-TO-DO  PATIENT  AT  WORK          59 

ing  expedition  will  do.  The  trouble  with  these 
expedients  is  that  he  gets  away  from  medical 
advice,  a  very  good  thing  to  do  if  he  is  well 
enough,  and  a  bad  enough  practice  otherwise. 
A  patient  who  tried  the  work  cure  at  Marble- 
head  and  who  used  blacksmithing  as  a  means 
to  the  desired  end,  said  after  working  for  a 
week,  "It  is  the  most  refreshing  thing  I  ever 
did.  When  I  get  to  thinking  about  myself 
or  my  business,  I  burn  my  fingers.  I  keep  my 
mind  on  the  iron  because  I  have  to." 

Medical  workshops  in  private  practice  or  in 
connection  with  sanatoriums  will  come  more 
and  more  into  vogue  because  the  need  of  simple 
work  for  nervous  men  and  women  is  becoming 
every  day  more  widely  recognized.  It  is  not 
enough  to  say  to  the  sensitive  and  overwrought 
woman,  "You  need  to  simplify  your  life  by 
work  with  your  hands."  We  must  be  more 
explicit.  The  direction  of  such  work  is  a  fine 
art.  A  man  nervously  ill  may  try  to  work  in 
the  garden  on  the  advice  of  his  physician.  The 
result  may  be  a  miserable  failure  with  an  added 
disgust  for  gardening  because  such  general  di- 
rection will  not  do  at  all.  The  patient  must 
know  how  much  work,  just  what  kind  of  work, 


00  THE  WORK  OF  OUR  HANDS 

and  when  to  do  it.  To  direct  work  carefully, 
to  know  when  to  advise  it,  and  when  not,  is  an 
especial  branch  of  medicine  requiring  experi- 
ence and  equipment. 

For  the  well-to-do  there  are  very  attractive 
possibilities  along  the  line  of  medical  occupa- 
tions. It  should  be  possible  with  the  aid  of  a 
silversmith,  for  instance,  for  the  overwrought 
lawyer  to  acquire  an  avocation  that  would  keep 
his  mind  in  the  best  possible  condition.  Golf 
might  do  it,  but  the  season  often  interferes 
and  there  is  something  about  work  with  tangi- 
ble results  that  discounts  sport  in  the  end. 

For  the  well-to-do,  work  with  the  hands 
may  be  a  potent  remedy  against  the  harmful 
effect  of  idleness.  Last  of  all  it  may  open  the 
heart  and  mind  to  a  greater  respect  for  labor. 
If  men  who  are  themselves  benefited  make  it 
possible  for  handicapped  people  of  the  poorer 
classes  to  find  specialized  and  adapted  work 
when  they  need  it,  then  the  work  cure  will  have 
fulfilled  a  wide  and  useful  purpose. 


VII 

THE  INDUSTRIAL  PROBLEM  OF  THE 
TUBERCULAR 

EXPERIENCE  has  shown  that  the  tuberculous 
patient,  except  in  the  actively  febrile  stages  of 
the  disease,  is  not  only  capable  of  a  good  deal 
of  physical  exertion  but  that  he  may  be  actu- 
ally benefited  by  it.  Nevertheless  the  known 
possibilities  of  contagion,  and  the  general 
prejudice  against  work  for  invalids,  have 
greatly  narrowed  the  field  of  possible  occupa- 
tion. Vast  numbers  of  tubercular  convales- 
cents await  a  possible  release  from  the  eco- 
nomic and  moral  slavery  of  idleness.  The 
"arrested"  tubercular  cases,  when  they  work 
at  all,  drift  back  naturally  to  their  old  occupa- 
tions and  to  the  old  conditions  under  which 
the  disease  developed.  The  unsuitable  occu- 
pations are  the  recognized  cause  of  a  great  pro- 
portion of  the  relapses.  With  the  tubercular 
it  is  the  cardiac  situation  over  again — the  same 

61 


62  THE  WORK  OF  OUR  HANDS 

necessity  for  work,  the  same  certainty  of  break- 
ing down  and  the  same  poor  economy  for  char- 
ity to  build  up  the  patient  only  to  have  him 
break  down  again  and  again — coming  back  for 
more  expensive  hospital  or  sanatorium  treat- 
ment. It  is  poor  economy  and  it  is  to  a  con- 
siderable extent  an  unnecessary  waste,  for  as 
has  been  demonstrated  in  a  small  way  with  the 
heart  cases — a  lighter,  more  favorable  labor 
may  not  only  bring  its  money  return,  but  may 
prove  a  positive  therapeutic  value. 

The  situation  for  the  tubercular  does  not 
present  all  the  difficulties  of  the  cardiacs  be- 
cause the  regular  work  of  the  tubercular  is 
usually  not  so  severe  in  physical  exactions.  A 
very  great  proportion  of  the  tubercular  in  cities 
comes  from  the  garment  industries.  Here  we 
shall  find  excellent  conditions  for  transmission 
of  the  disease.  Here  are  close,  hot  rooms  full 
of  dust — and  many  workers  in  small  space. 
In  these  shops  there  are  usually  inadequate 
lavatory  accommodations  and  a  thousand  op- 
portunities for  direct  infection.  The  hours 
and  the  work  itself  are  trying  enough,  but  the 
actual  physical  effort  is  often  not  so  very  great. 
If  these  people  could  work  at  the  same  trade 


INDUSTRIAL  PROBLEM  OF  THE  TUBERCULAR      63 

under  very  much  better  conditions  it  is  reason- 
able to  suppose  that  there  would  be  less  tuber- 
culosis. Suppose  an  out-of-doors  shop  in  sum- 
mer, and  an  especially  ventilated  one  in  winter 
—suppose  plenty  of  space  between  machines 
and  every  hygienic  facility — such  a  shop 
would  be  a  good  place  for  the  tubercular  con- 
valescent to  work.  He  would  have  the  tre- 
mendous advantage  of  using  his  own  well- 
learned  trade  and  if  he  were  guarded  against 
overwork  it  is  reasonable  to  suppose  that  he 
would  be  far  less  likely  to  break  down  than 
would  be  the  case  if  he  went  unrestricted  back 
to  the  old  shop.  If  practical  clothing  manu- 
factories could  be  established  in  connection  with 
the  tubercular  sanatoriums  or  the  tubercular 
camps  in  the  cities  we  might  see  a  great  ad- 
vantage gained  in  the  fight  against  this  dis- 
ease. There  are  many  points  in  favor  of  such 
a  plan.  Its  hygienic  and  economic  benefits 
might  be  enormous.  The  State  could  well  af- 
ford to  pay  the  market  price  for  the  products. 
If  the  labor  unions  were  to  object  to  this  kind 
of  labor  the  answer  is  very  simple — let  the 
product  be  paid  for  and  used  by  the  State. 
Another  and  more  insistent  objection  will  be 


64  THE  WORK  OF  OUR  HANDS 

raised:  Is  it  not  dangerous  to  put  into  use 
garments  made  by  tubercular  workers?  The 
answer  is  straight  and  strong:  There  is 
scarcely  a  regular  clothing  shop  of  any  size 
that  does  not  employ,  knowingly  or  unknow- 
ingly, tubercular  workers.  There  is  no  at- 
tempt made  to  sterilize  the  products — they  are 
sent  out  and  accepted  by  the  trade.  Undoubt- 
edly, the  garments  made  in  the  regular  shops 
carry  possible  infection.  The  garments  made 
in  special — tubercular — shops  would  all  be 
sterilized  as  a  matter  of  course — they  would 
therefore  on  the  chances  be  safer  to  use  than 
those  from  the  regular  shops. 

It  has  been  suggested  that  tubercular  con- 
valescents be  settled  on  farms,  that  they  at- 
tempt market  gardening  and  the  like.  Here 
the  objection  to  tubercular  labor  is  plain 
enough.  Most  city  dwellers  would  find  farm 
life  wholly  impractical  because  they  prefer  the 
city  and  do  not  like  farming,  which  is  quite 
out  of  their  line.  More  than  this,  while  mar- 
ket gardening  and  farming  might  be  ideal 
work  for  the  tubercular,  there  would  undoubt- 
edly be  possibilities  of  infection. 

The  tuberculosis  camps  and  sanatoriums  are 


INDUSTRIAL  PROBLEM  OF  THE  TUBERCULAR      65 

performing  scarcely  more  than  half  their  duty 
when  they  cure  or  arrest  the  disease.  They 
are  not  fulfilling  their  duty  even  when  they 
maintain  a  corps  of  social  service  workers  or 
nurses  to  go  to  the  homes  of  former  patients 
in  the  interests  of  hygiene  and  social  better- 
ment. Sooner  or  later  the  State  must  take 
seriously  the  problem  of  employment  for  the,/ 
tubercular  convalescents.  If  the  tubercular 
are  state  charges,  it  is  only  fair  and  reasonable 
that  they  should  partly  support  themselves,  if 
this  is  possible  without  detriment./ 

Unquestionably  it  is  good  judgment  to  make 
use  of  already  learned  trades  if  these  can  be 
adapted  to  the  new  requirements.  The  cloth- 
ing trade  seems  to  offer  many  advantages — • 
chief  among  which  is  the  fact  that  the  product 
could  be  used  and  regulated  by  the  State,  and 
that  the  State  might  well  afford  to  pay  the 
workers  enough  to  make  the  exertions  worth 
their  while.  Foremen  and  skilled  instructors 
could  undoubtedly  be  found — the  business  end 
could  be  taken  care  of.  There  should  be  no 
delay  in  trying  out  a  plan  that  promises  so 
much. 


VIII 

HANDICAPPED  LABOR  AND  THE  LAW 

WORKINGMEN'S  Compensation  is  still  new  in 
this  country.  It  is  as  yet  impossible  to  pre- 
dict what  the  final  adjustments  will  be.  This 
much  is  certain:  that  the  manufacturers  must 
pay  something,  probably  two-thirds  of  the  in- 
jured employee's  usual  wages  during  times  of 
disability  even  if  the  disability  is  long  con- 
tinued. This  payment  will  usually  be  made 
of  course  by  the  liability  companies.  In 
Massachusetts,  at  least,  the  liability  company 
diminishes  its  payments  proportionately  if  any 
money  is  earned  by  the  workman  during  the 
period  of  disability.  Furthermore  the  com- 
pany has  the  right  to  find  or  recommend  light 
occupation  for  the  injured  workman.  If  this 
occupation  is  approved  by  a  board  of  arbitra- 
tion the  workman  must  perform  it  or  lose  his 
compensation  altogether.  It  is  evident  that 
this  provision  would  do  away  with  unneces- 

66 


HANDICAPPED  LABOR  AND  THE  LAW  67 

sarily  long  convalescence  on  the  part  of  indi- 
viduals inclined  to  take  advantage  of  the  liber- 
ality of  the  law.  Apparently  the  liability 
companies  might  with  profit  to  themselves  and 
advantage  to  their  clients  actually  assist  in  the 
founding  and  maintenance  of  specialized  in- 
dustries for  the  partial  employment  of  the 
handicapped.  Let  us  suppose  that  a  man 
earning  $10  a  week  is  disabled  by  a  crushing 
injury  to  one  hand.  Some  of  these  injuries 
are  a  long  time  healing — four  months  might 
not  be  an  unreasonable  period  of  disability. 
This  would  mean  a  total  payment  of  $106.72. 
If  after  the  first  month  the  man  could  earn  $6 
a  week  in  a  hospital  workshop  the  company 
would  make  a  saving  of  $4  a  week  for  three 
months — a  total  of  $48.  It  would  not  seem 
an  unreasonable  arrangement  to  return  half 
of  this  saving  to  the  workshop  and  some  por- 
tion of  the  other  half  to  the  employer  in  the 
way  of  reduced  premiums. 

If  these  specialized  workshops  are  under 
hospital  control  there  will  be  no  danger  of  in- 
justice to  the  handicapped  worker,  for  the 
physical  condition  will  be  carefully  studied  and 
the  work  carefully  adapted  to  the  case.  This 


68  THE  WORK  OF  OUR  HANDS 

is  a  new  aspect  of  the  situation  but  one  worth 
the  consideration  of  employers,  insurance 
companies  and  hospitals. 

Industrial  accident  problems  are  likely  to 
grow  more  and  more  perplexing  for  some  time 
to  come.  The  number  of  the  unemployed  will 
be  increased  by  the  unwillingness  of  the  insur- 
ance companies  to  allow  the  handicapped  in  any 
regular  industry.  The  companies  cannot  be 
blamed  for  this  because  the  danger  of  accident 
is  increased  by  such  employment.  So  we  shall 
see  the  growing  necessity  for  an  adequate  sys- 
tem of  handicapped  labor — protected  and  en- 
couraged by  manufacturers,  by  insurance 
companies  and  by  the  charities.  From  the 
point  of  view  of  the  injured  employee  there  is 
advantage  both  moral  and  financial  to  be  found 
in  low  pressure  industries.  So  far  as  early 
and  very  limited  observation  go  the  men  are  as 
a  rule  glad  to  be  at  work,  especially  when  it 
means  the  learning  of  a  new  trade  which  may 
save  them  from  final  dependence.  There  are 
many  cases  in  which  the  injured  employee 
through  no  fault  of  his  own  gets  out  of  the 
way  of  work — loses  his  knack  and  becomes 
dependent.  Sometimes  a  carefully  conducted 


HANDICAPPED  LABOR  AND  THE  LAW  69 

campaign  of  modified  occupation  would  save 
such  an  unfortunate  occurrence.  There  are 
many  trades  which  could  support  a  hand  work- 
ing department  on  low  wages  with  benefit  to 
all  concerned.  The  product  would  be  small 
but  it  need  not  be  inferior  and  it  is  conceivable 
that  cleverness  of  design  and  special  workman- 
ship might  produce  surprising  results.  It  is 
probable  that  the  employer  could  afford  in 
many  instances  to  conduct  such  a  side  line  since 
he  would  pay  less  for  his  product  and  since  he 
might  in  this  way  reduce  in  time  the  size  of  his 
insurance  premiums. 


PART  II 
I 

TEACHING  OF  THE  HANDICAPPED 
Introduction 

IN  directing  the  handicapped,  the  manual 
training  teacher  must  solve  many  complex  and 
peculiar  problems. 

The  work  here  described  covers  about  ten 
years  of  personal  experience,  and  includes 
groups  of  handicapped  students,  such  as  those 
deformed  from  childhood,  those  crippled  by 
accident  or  old  age  so  that  they  have  ceased  to 
be  wage  earners ;  and  a  large  number  suffering 
from  functional  and  organic  nervous  diseases, 
and  from  mental  diseases. 

In  some  cases  work  has  gone  on  with  the 
same  pupil  for  several  years,  and  he  has  be- 
come sufficiently  expert  to  need  only  super- 
vision, not  instruction,  and  to  earn  a  modest 
income.  It  may  be  definitely  stated  that  the 

71 


72  THE  WORK  OF  OUR  HANDS 

work  has  been  sufficiently  hopeful  to  be  con- 
vincing of  the  great  possibilities  of  handicrafts 
in  the  future,  not  only  as  a  means  of  reclaim- 
ing to  productive  industry  many  at  present  in- 
capacitated through  illness  or  lack  of  proper 
training,  but  as  a  therapeutic  agent  of  great 
value.  In  every  community,  even  the  smallest 
village,  there  are  people  who  never  get  the  sat- 
isfaction which  work  gives.  The  household  in- 
dustries of  a  hundred  years  ago  were  usually 
carried  on  in  such  a  way  that  even  the  crippled 
and  mentally  deficient  had  their  share,  and 
there  were  few  drones  in  the  hive.  Weaving, 
shoe  making,  coopering,  cane  and  rush  seating, 
netting,  and  other  handicrafts  were  planned 
so  that  some  humble  share  could  be  assigned 
even  to  the  least  efficient.  It  appears  that  it 
is  through  such  simple  means  that  the  incompe- 
tent may  still  be  rehabilitated.  Some  of  these 
industries  can,  of  course,  be  carried  on  better 
by  machinery,  but  there  are  many  which,  like 
chair  caning  and  cobbling,  can  still  be  best  done 
by  hand,  and  others  in  which  cooperative  work 
can  be  done,  as  in  cement  work,  so  as  to  employ 
several  individuals. 

In  the  large  cities  the  hospital  clinics  are 


TEACHING  OF  THE  HANDICAPPED  73 

visited  by  "chronics"  who  never  get  quite  well 
enough  to  work  at  anything  our  complex  city 
life  affords,  and  often  end  prematurely  in  the 
almshouse.  Among  such  are  rheumatics,  par- 
alytics, cardiac  cases,  the  partially  blind,  all 
able  to  do  a  little  if  only  the  way  could  be 
pointed  out,  and  that  along  lines  where  they 
would  not  compete  with  other  people  strug- 
gling to  earn  a  livelihood. 

The  ideal  plan  in  the  work  cure  is  to  have  a 
craftsman  who  plans  the  work,  the  details  of 
which  are  carried  out  by  a  teacher  or  a  teach- 
ing nurse.  But  in  many  places,  especially 
where  the  work  is  first  introduced,  the  design- 
ing and  teaching  fall  to  the  lot  of  one  person. 

In  order  to  succeed  in  teaching  any  craft  the 
instructor  must  be  familiar  with  every  detail 
and  enthusiastic  over  that  particular  industry, 
but  if  her  mind  is  so  concentrated  on  fine  crafts- 
manship that  she  is  indifferent  to  human  in- 
terests, she  will  surely  fail  in  this  new  field. 
She  is  not  merely  teaching  him  how  to  work, 
but  how  to  think,  how  to  use  disused  members, 
how  to  work  effectively  when  he  is  unused  to 
working  at  all.  She  must  be  able  to  rouse  in- 
terest in  him  when  he  does  not  want  to  be  in- 


74  THE  WORK  OF  OUR  HANDS 

terested,  and  to  detect  the  difference  between 
laziness,  which  she  has  to  help  him  to  outgrow, 
and  fatigue,  which  she  must  give  him  a  chance 
to  overcome  by  proper  rest.  She  must  be  pre- 
pared for  sudden  flagging  in  interest,  and  "off 
days"  when  nothing  goes  right  with  him.  She 
may  be  so  fortunate  as  to  have  a  physician  to 
do  some  of  the  thinking  for  her,  and  a  nurse 
to  watch  the  signs  of  fatigue,  but  still  the  fact 
remains  that  the  brunt  of  the  daily  routine 
must  fall  on  her,  and  if  this  constant  adapting 
of  the  work  to  individual  needs  seems  boring 
to  her,  she  is  not  fitted  for  this  kind  of  teach- 
ing; if  she  is  adapted  for  it  the  difficulties 
enumerated  will  only  add  zest  to  the  game. 

The  quality  which  is  indispensable  in  a 
teacher  of  the  handicapped  is  an  ability  to 
rouse  interest,  and  this  can  be  largely  culti- 
vated. All  manual  work  is  in  itself  so  full  of 
charm  that  the  teacher  ought  to  be  able  to  se- 
lect the  salient  features  so  as  to  call  the  pa- 
tient's attention  to  them,  even  in  humble  indus- 
tries like  basketry;  but  she  must  be  perfectly 
familiar  with  her  subject;  for  instance,  a  bas- 
ketry teacher  ought  to  know  how  to  make 
at  least  twenty  kinds  of  baskets  for  every  con- 


TEACHING  OF  THE  HANDICAPPED  75 

ceivable  purpose,  and  have  some  good  samples, 
and  then  she  has  a  sure  frame  work  on  which 
to  build  up  her  fabric  of  interest. 

A  very  necessary  quality  is  patience — will- 
ingness to  look  ahead  for  results,  to  work  with 
almost  imperceptible  advance  from  day  to 
day,  sometimes  to  allow  for  backslidings  in 
health  or  interest  on  the  part  of  the  pupil  and 
to  overlook  little  peculiarities  due  to  invalid- 
ism  or  depression,  such  as  irritability  and  fits 
of  pique  against  the  teacher  or  the  work. 

Another  quality  to  be  cultivated  is  farsight- 
edness. The  question  often  arises  as  to  how  a 
certain  person  should  be  trained.  Physical 
and  mental  ability  must  be  considered,  but  the 
work  selected  should  be  based  on  the  physi- 
cian's judgment.  Is  the  work  given  to  be  a 
temporary  diversion,  a  means  of  cure,  or  is  it 
something  to  be  part  of  the  patient's  life,  either 
as  an  absorbing  interest  or  a  source  of  income? 
In  the  first  instance  the  teacher  might  be  justi- 
fied in  giving  pieces  of  work  pleasing  as  speci- 
mens, which  do  not  show  any  special  progres 
sion.  A  convalescent  from  typhoid  might  be 
amused  by  work  which  would  be  a  waste  of 
time  for  a  cripple  who  needed  to  spend  his  time 


76  THE  WORK  OF  OUR  HANDS 

on  something  which  might  be  helpful  to  him 
physically,  or  lead  to  some  financial  benefit. 

Physician  and  Teacher 

There  must  be  a  complete  understanding 
between  the  doctor  and  the  teacher  as  to  how 
much  may  reasonably  be  expected  of  the  pa- 
tient. No  person  so  ill  as  to  be  in  a  sanatorium 
or  under  the  care  of  a  physician  at  home  can 
work  like  a  normal  individual.  The  amount 
to  be  done,  the  nature  of  the  work,  whether  it 
should  require  much  or  little  physical  strength, 
whether  it  should  stimulate  the  creative  pow- 
ers or  be  of  a  restful  monotony,  all  these  points 
should  be  made  clear  to  the  teacher.  Such 
conditions  can  be  condensed  into  a  few  words 
on  a  card,  as  per  example — 

May  1,  1914 

Occupation  work 

Mrs.  X — Room  50 

Light  occupation  in  bed. 

Basketry  or  Knitting. 

Not  more  than  1  hour  daily. 

,  M.D. 


TEACHING  OF  THE  HANDICAPPED  77 

May  1,  19U 

Mr.  D ,  Ward  £. 

Occupation  in  workshop. 
Heavy  Work.     3  hours  daily. 
Running  Printing  Press. 

,  M.D. 

The  teacher's  province  is  particularly  to 
start  the  patient  working,  and  make  him  feel 
that  work  is  worth  doing.  The  carrying  out 
of  the  directions  may  then  be  left  to  a  nurse 
or  an  attendant.  Often  the  physician  can 
pave  the  way  for  the  teacher  by  trying  to  in- 
terest the  patient  and  make  him  feel  that  work 
is  a  privilege,  not  a  penance. 

The  question  as  to  whether  it  is  necessary 
for  the  teacher  to  know  the  diagnosis  and  fam- 
ily history  of  a  patient  is  one  often  raised  by 
new  teachers.  Generally  speaking,  it  is  not 
necessary.  Work  is  one  of  the  few  normal 
habits  left  to  the  patient,  and  the  nearer  he 
can  approach  to  health  in  his  relations  with 
the  teacher  the  better.  A  knowledge  of  the 
nature  of  his  illness  and  the  causes  leading  to 
it  are  liable  to  lead  the  teacher  and  patient  into 
unprofitable  conversations. 


78  THE  WORK  OF  OUR  HANDS 

On  the  other  hand  there  are  certain  diseases 
in  which  the  therapeutic  value,  and  there  are 
others  in  which  the  social  value  of  work  is 
greatly  enhanced  hy  the  knowledge  of  the  pa- 
tient's especial  discouragements  and  disabili- 
ties. Where  the  physician  feels  that  the 
teacher  can  cooperate  with  him  more  closely 
by  knowing  the  nature  of  the  patient's  malady, 
he  will  generally  be  glad  to  inform  her.  Work 
for  a  definite  aim  is  naturally  more  interesting 
to  the  teacher,  and  the  writer's  own  experience 
has  been  that  when  she  worked  intelligently 
with  the  physician  to  obtain  a  certain  result  the 
occupation  was  much  more  satisfactory. 

The  teacher  should  remember  in  making  re- 
ports to  the  physician  in  regard  to  occupation 
work  that  they  should  be  concise.  Where 
there  is  any  marked  peculiarity,  such  as  long 
continued  apathy  in  regard  to  work,  or  stub- 
born opposition,  it  should  be  reported,  as  it 
may  indicate  an  abnormal  mental  condition. 

The  physician  who  has  a  trained  nurse  look- 
ing after  a  patient  can  call  on  her  to  aid  the 
teacher,  who  may  see  her  pupil  only  three  or 
four  times  a  week.  Generally  the  nurse  be- 


TEACHING  OF  THE  HANDICAPPED  79 

comes  interested,  and  works  with  her  patient, 
which  is  stimulus  to  both. 

In  some  hospitals,  occupation  work  for 
nurses  covering  only  work  which  can  be  done 
without  equipment  in  the  patient's  home  has 
proved  useful.  The  course  includes  the  mak- 
ing of  a  few  reed  and  raffia  baskets,  caning  a 
chair,  binding  a  kodak  album,  etc.,  and  takes 
one  evening  a  week  for  six  months.  It  enables 
the  nurse  to  supplement  the  work  of  the  crafts- 
man teacher,  and  in  some  instances,  to  work 
with  the  patient  without  this  supervision. 
Nearly  every  nurse  who  has  taken  this  work 
has  reported  it  as  being  of  practical  value,  par- 
ticularly in  dealing  with  nervous  invalids. 

Study  of  the  Patient 

Work  with  invalids  may  be  roughly  grouped 
into  two  classes: — 

A.  Palliative. 

B.  Remedial. 

What  is  called  diversional  occupation  might 
be  put  into  the  first  group,  and  would  be  suit- 
able for  patients  in  receiving  hospitals  who 
remain  only  a  week  or  so  for  diagnosis,  and  for 


80  THE  WORK  OF  OUR  HANDS 

patients  in  the  advanced  stages  of  cancer  or 
tuberculosis,  to  whom  nothing  could  do  more 
than  brighten  the  weary  hours.  (Yet  some 
very  good  work  is  done  in  homes  for  incurables 
and  it  may  be  noted  that  even  with  such  hope- 
less cases  real  work  like  basketry,  knotted  raffia 
bag  making  or  coarse  knitting,  seems  to  give 
more  pleasure  than  the  making  of  egg-shell 
dishes,  and  paper  furniture,  sometimes  called 
diversional  occupation,  but  which  would  seem 
most  suitable  for  children.) 

Remedial  work  may  be  subdivided  into  that 
which  is  done — 

1.  For  its  therapeutic  value,  as  a  means  of 
treatment,  and  that  which  is  done — 

2.  For  its  economic  value,  to  enable  the  pu- 
pil to  become  master  of  some  handicraft  which 
will  bring  him  money. 

The  remarkable  success  which  has  followed 
the  attempts  to  teach  industrial  work  to  the 
blind  and  crippled  show  the  possibilities  along 
these  lines.  Other  groups,  like  epileptics, 
cardiac  cases,  dementia  praecox  cases,  etc.,  are 
now  being  worked  with  in  the  same  way  to  put 
them  in  a  position  to  earn  a  livelihood. 

In  the  effort  to  consider  the  practical  value 


TEACHING  OF  THE  HANDICAPPED  81 

of  occupation  work,  the  effect  on  character 
must  not  be  overlooked.  Work  is  so  much  a 
part  of  the  normal  human  life  that  the  absence 
of  it  for  any  length  of  time  throws  the  indi- 
vidual out  of  balance.  In  old  people's  homes 
the  inmates  are  often  full  of  petty  feuds  and 
foolish  animosities;  in  nearly  every  such  insti- 
tution where  occupation  work  has  been  intro- 
duced life  has  become  happier.  In  hospitals 
where  patients  are  allowed  work  to  while  away 
the  time,  they  have  had  one  tie  to  hold  them  to 
the  work  of  health  and  activity,  and  have  had, 
too,  less  time  in  which  to  meditate  on  their  own 
sufferings  and  on  the  shortcomings  of  their 
nurses.  They  have  often  got  new  interests  in 
life.  Industrial  teachers  have  often  received 
letters  of  thanks  from  patients  taught  only  a 
few  weeks. 

In  choosing  work  of  economic  value  it  is  im- 
portant to  know  whether  the  prognosis  for  the 
patient  is  for  an  early  and  complete  disability 
or  for  a  long  semi-invalidism.  The  patient 
should  always  be  studied  for  some  time  before 
any  handicraft  is  chosen  as  a  possible  means 
of  livelihood. 

The  attitude  of  the  patient  toward  work  is 


82  THE  WORK  OF  OUR  HANDS 

often  puzzling  to  the  inexperienced  instructor. 
The  habit  of  invalidism  is  the  strongest  habit 
in  the  prospective  pupil,  and  to  bring  him  back 
to  the  normal  attitude  toward  work  as  an  es- 
sential part  of  the  daily  routine  takes  tact  and 
perseverance.  There  are  some  pupils  who 
plunge  into  work  with  a  feverish  eagerness, 
which,  if  unrestrained,  soon  tires  them  out,  and 
there  are  others  who  are  so  preoccupied  with 
their  symptoms  that  they  have  little  thought 
to  spare  for  work.  Besides  these  there  is  an 
apathetic  class,  easily  bored,  complaining  of  a 
fatigue  for  which  there  is  no  cause  apparent  to 
the  teacher,  in  the  physical  labor  attempted. 
This  is  perhaps  the  true  neurasthenic  type, 
easily  tired  and  easily  worried.  The  patient 
of  this  type  frequently  becomes  interested  and 
finally  enthusiastic;  he  often  develops  resources 
hitherto  unsuspected,  even  by  himself,  and  his 
return  to  health  may  result  in  his  living  on  a 
higher  plane  than  before  his  illness. 

Another  type  of  patient  shows  an  appar- 
ent indifference,  a  dullness  which  is  almost 
lethargic,  due  to  an  organization  so  poorly  en- 
dowed that  he  must  be  counted  a  "constitu- 
tional inferior"  or  a  "mental  inferior" ;  he  lacks 


TEACHING  OF  THE  HANDICAPPED  83 

vigor  of  mind  and  body;  his  perceptive  facul- 
ties are  dull,  and  his  muscles  flabby  so  that 
little  beauty  reaches  him  through  the  senses, 
and  he  cannot  get  much  pleasure  from  using 
his  strength  or  skill.  A  most  unpromising 
outlook,  yet  such  individuals,  children  and 
adults,  have  frequently  a  surprising  degree  of 
"stick-to-it-iveness,"  and  well  chosen  work  sim- 
ple enough  to  be  done  well,  but  not  lacking  in 
variety,  may  provide  a  road  along  which  they 
may  walk  happily.  Our  complex  civilization 
offers  a  poor  foothold  for  such  as  these,  but  the 
teacher  who  can  understand  this  apparent  in- 
difference, and  rouse  the  latent  activity,  may 
find  there  is  truth  in  what  William  Penn  once 
boldly  asserted,  that  "Industry  supplies  the 
want  of  parts." 

Helping  such  individuals  as  this  is  peculiarly 
the  province  of  the  teacher,  rather  than  that 
of  the  physician  or  nurse.  There  must  be  a 
continued  appeal  to  the  pupil's  interest  and  a 
constant  variety  in  the  method  in  which  work 
is  presented,  with  adults  as  well  as  with  chil- 
dren of  this  type.  If  there  is  any  one  talent, 
however  trifling  it  may  seem,  it  must  be  made 
much  of  to  give  self-confidence.  Much  work 


84  THE  WORK  OF  OUR  HANDS 

of  this  kind  is  already  being  done  with  children, 
but  it  is  the  writer's  conviction  that  in  a  few 
years  the  field  will  be  enlarged  to  include 
adults  who  have  never  "made  good,"  but  who, 
under  proper  training,  will  develop  unexpected 
capabilities.  "Efficiency  tests"  such  as  are 
now  used  in  many  industrial  concerns  may  in 
time  be  applied  to  bring  out  abilities  in  such 
persons.  Meanwhile,  it  will  be  seen  that  the 
initial  attitude  of  the  pupil,  in  any  of  these 
groups,  counts  for  little,  and  the  teacher's  at- 
titude is  the  important  one.  If  she  is  fully 
convinced  herself  that  honest  work  is  the  back- 
bone of  life,  her  work-room  will  be  cheery, 
and  her  pupils,  no  matter  how  depressed  on 
beginning,  will  become  imbued  with  this  op- 
timistic spirit  of  the  true  craftsman  who  sings 
at  his  work.  If  there  are  expert  workers  who 
are  not  invalids,  or  those  cured  of  their  ills, 
working  at  the  same  craft,  it  often  adds  to  the 
feeling  of  stability  on  the  patient's  part. 
Work  no  longer  seems  a  therapeutic  agent, 
ordered  by  the  doctor  along  with  Nauheim 
baths,  and  eight  eggs  a  day,  but  a  natural, 
wholesome  part  of  life. 


II 

METHODS  OF  TEACHING 

THE  methods  of  teaching  invalid  pupils  must 
vary  with  the  facilities  at  hand  and  with  the 
nature  of  the  diagnosis.  Sufferers  from 
purely  physical  maladies  uncomplicated  with 
"nerves"  may  work  together  comfortably  in 
large  classes  for  several  hours  at  a  stretch. 
They  often  show  unexpected  powers  of  endur- 
ance ;  cripples,  especially,  seem  often  to  be  able 
to  work  a  long  time  without  change  of  posi- 
tion. Perhaps  nature  in  adapting  them  to 
live  handicapped  by  deformity  has  given  them 
an  armor  which  makes  them  fatigue-proof. 
Often,  too,  suffering  has  given  them  "the 
philosophic  mind,"  and  they  can  make  the  best 
of  circumstances  and  work  skillfully  and  hap- 
pily under  trying  conditions,  unwilling  to  ad- 
mit that  they  are  tired.  As  a  matter  of  fact, 
physicians  assert  that  few  cripples  are  inca- 
pacitated for  steady  work,  and  the  considera- 

85 


86  THE  WORK  OF  OUR  HANDS 

tion  of  methods  may  concern  itself  with  physi- 
cal conditions,  such  as  proper  tables  and  chairs 
for  individuals,  and  the  selection  of  work, 
adapted  to  peculiar  physical  limitations. 

The  methods  of  work  with  those  suffering 
from  nervous  and  mental  diseases  is  a  much 
more  complex  problem.  The  question  of  the 
necessity  for  individual  teaching  is  an  impor- 
tant one.  Wherever  possible,  the  worker 
should  be  made  to  feel  himself  an  essential  unit 
of  a  whole ;  but  in  many  cases,  if  he  is  unused 
to  work,  he  must  have  an  opportunity  for  un- 
disturbed effort  until  he  becomes  accustomed 
to  the  work-room.  A  secluded  corner  may 
save  much  weariness  of  mind  and  body,  as  well 
as  the  avoidance  of  errors  in  his  work.  The 
noise  of  machinery,  conversation,  or  any  out- 
side sound,  disturbs  the  attention  of  one  long 
unaccustomed  to  work.  Often  such  a  patient 
does  better  at  first  in  his  own  bedroom;  his  in- 
terest can  be  roused  so  he  is  in  a  receptive  at- 
titude toward  work  in  the  shop  before  he  be- 
gins to  work  there.  On  the  other  hand,  some 
depressed  patients  become  interested  at  once 
in  the  work  of  others;  their  spirits  rise  with 
the  sight  of  cheerful,  industrious  people,  and 


METHODS  OF  TEACHING  87 

the  sooner  they  get  in  the  midst  of  a  group  the 
better.     Such  points  in  regard  to  the  manage- 
ment of  the  work-room  may  generally  be  best 
settled  by  the  physician  who  knows  the  pa- 
tients' temperaments.     These  details  are  much 
more  important  than  they  may  appear.    We 
all  remember  that  the  nearest  neighbors  in  our 
school  days  were  influential  in  helping  or  hin- 
dering our  work;  no  one  is  so  completely  ab- 
sorbed in  work  as  to  be  oblivious  to  his  neigh- 
bors, even  in  a  factory.     This  is  eminently  true 
in  regard  to  the  grouping  of  workers  where  the 
craftsmen  are  invalids,  and  great  tact  must  be 
used  in  order  to  keep  the  atmosphere  whole- 
some.    Praise  for  effort  should  be  given  un- 
grudgingly ;  but  praise  of  results  should  not  be 
too  lavish.     Sometimes  a  piece  of  work  which 
looks  very  simple  is  the  first  actual  accomplish- 
ment for  years  in  the  way  of  handicrafts,  and 
to  carry  it  to  completion  is  a  milestone  in  the 
way  to  recovery.     It  is  often  difficult  to  decide 
whether  a  patient  should  stick  to  one  thing  un- 
til it  is  completed,  or  should  be  allowed  variety. 
There  are  some  nervous  invalids  who  are  al- 
ways craving  change,  their  interest  needs  con- 
tinual fillips  produced  by  new  work.     Such 


88  THE  WORK  OF  OUR  HANDS 

patients  may  have  been  under  the  charge  of 
many  physicians,  and  may  have  wandered  from 
Maine  to  California.  Trying  to  hold  them  to 
one  thing  sometimes  arouses  stubbornness.  It 
is  a  good  plan  to  have  a  variety  of  the  same 
kind  of  work,  so  that  the  interest  may  be  kept 
up,  while  the  patient  is  still  working  at  the 
same  craft.  Sometimes,  too,  it  is  wise  to  allow 
the  patient  a  liberty  of  choice  in  order  to  find 
any  genuine  talent  for  some  kind  of  work. 


Ill 

READJUSTMENT 

ONE  who  falls  a  victim  to  any  organic  disease 
may  remain  the  same  in  character,  his  quali- 
ties and  inclinations  may  be  unchanged,  the- 
oretically he  may  be  the  same  individual,  but 
not  infrequently  he  has  changed  from  a  plus 
quantity  to  a  minus.  If  he  becomes  a  plus 
again  it  is  because  his  efficiency  has  survived, 
and  he  has  devised  some  means  by  which  he 
can  carry  on  his  work,  or  because  he  has  mani- 
fested an  adaptability  which  has  enabled  him 
to  turn  his  energies  into  new  channels.  But, 
unfortunately,  before  he  is  in  a  condition  to 
readjust  his  life  to  changed  circumstances  he 
must  go  through  a  period  of  mental  struggle, 
if  he  is  at  all  sensitive,  almost  as  hard  to  bear 
as  his  physical  pain.  To  become  a  burden  to 
his  friends,  or  worse  still  to  rely  on  public 
charity,  to  become  unable  to  walk,  to  have 
years  of  suffering  as  his  only  future  outlook, 


90  THE  WORK  OF  OUR  HANDS 

these  forebodings  of  evil  only  too  often  rivet 
his  attention.  Character  is  prone  to  dete- 
riorate under  such  a  strain;  the  patient  is  liable 
to  become  despondent,  leaning  on  others  and 
demanding  an  unnerving  pity  which  makes 
him  feel  more  and  more  that  his  sufferings  are 
undeserved,  or  he  may  shut  himself  away  from 
the  natural  wholesome  sympathy  which  would 
give  him  new  courage.  This  point  is  illus- 
trated by  a  physician's  letter  to  a  patient  suf- 
fering from  an  agonizing  form  of  heart  dis- 
ease, in  which  the  following  sentence  occurs : — 
"Physical  pain  is  an  insidious  enemy,  and  we 
cannot  come  to  the  end  of  the  trap  that  it  can 
lay  for  us  in  our  imaginations.  Above  all, 
avoid  falling  in  love  with  your  own  inevitable 
isolation;  and  do  not  use  the  conquered  tor- 
ments of  your  body  as  stones  to  build  a  walled 
castle  for  your  mind."  Perhaps  no  real  physi- 
cian would  write  to  a  patient  in  such  language 
(this  one  lives  in  the  pages  of  a  novel) ,  but  he 
has  hit  on  a  danger  which  needs  pointing  out, 
and  one  in  which  a  thoughtful  teacher  can  be 
of  great  service  to  his  patient. 

The  teacher  who  is  associated  in  the  pa- 
tient's mind  with  the  activities  of  life,  with 


READJUSTMENT  91 

work  and  wages  and  other  mundane  interests, 
can  help  hold  him  to  these,  so  that  he  will  not 
necessarily  feel  himself  out  of  it  at  all.  How- 
ever handicapped  he  may  be  physically,  he  can 
be  made  to  feel  himself  still  an  individual  unit 
in  a  world  of  working  men  and  women,  that 
his  efficiency  is  merely  in  abeyance,  not  lost. 

This  period  when  the  patient  is  trying  to  be- 
come accustomed  to  his  unfamiliar  physical 
disability  is  perhaps  harder  for  him  to  bear 
than  an  actual  burden  of  invalidism  in  the  later 
years — but  frequently  it  is  the  teacher's  great 
opportunity.  The  results  of  occupation  work 
are  too  often  measured  in  terms  of  so  many 
baskets  or  so  many  pages  of  typewriting. 
Keeping  alive  the  desire  for  efficiency,  and 
stimulating  the  imagination  toward  develop- 
ing new  resources  are  always  legitimate  efforts. 
With  the  return  of  a  more  normal  state,  when 
mind  and  body  have  become  habituated  to  new 
conditions,  the  interest  in  occupation  may  well 
become  a  dominant  one.  Possibly  stored  up 
reservoirs  of  energy  are  tapped;  at  any  rate, 
there  is  often  a  surprising  degree  of  adaptation 
to  changed  conditions,  when  there  is  no  great 
improvement  in  actual  health. 


92  THE  WORK  OF  OUR  HANDS 

One  of  the  most  important  features  in  re- 
education is  the  opening  out  of  broader  inter- 
ests to  those  who  are  liable  to  remain  incapable 
of  getting  out.  The  "shut-in"  may  be  a 
pitiable  object,  or  he  may  be  a  person  with  a 
wide  knowledge  and  a  philosophical  mind.  It 
is  well  within  the  province  of  the  occupation 
teacher  to  open  new  channels  of  thought,  and 
to  clear  out  the  debris  from  long  disused  ones. 
Any  one  familiar  with  hospital  life  knows  that 
the  usual  basis  of  thought  is  illness,  compari- 
son of  symptoms  and  personal  experiences  in 
regard  to  physicians  and  nurses.  In  any  large 
city  hospital  there  are  many  nationalities  rep- 
resented, and  there  are  possibilities  for  real 
social  intercourse.  The  subject  of  national 
music,  for  instance,  is  one  of  real  interest,  and 
among  those  from  country  districts,  the  meth- 
ods of  agriculture,  and  primitive  industries. 
Men  and  women  whose  recent  work  has  been 
in  the  monotony  of  factories,  or  of  crowded 
tenements,  recall  with  pleasure  the  scenes  of 
their  childhood  in  Europe.  Old  crafts  are  dis- 
cussed, and  interest  in  handicrafts  is  stimulated 
by  such  social  intercourse.  Basketry,  for  in- 
stance, has  been  the  subject  in  the  writer's 


READJUSTMENT  93 

classes,  where  the  pupils  were  Italian,  Russian, 
Hungarian,  and  sometimes  German  or  Aus- 
trian. The  revival  of  old  memories  seemed  to 
distinctly  stimulate  their  mental  life. 

Men  and  women  alike  seem  to  be  benefited 
by  their  interest  in  a  common  handicraft. 
What  may  be  called  the  cultivation  of  the 
power  to  exchange  ideas  is  often  sadly  lacking 
in  the  lower  classes  of  the  great  cities.  If,  as 
has  been  said,  "The  happiness  of  life  depends 
very  largely  on  being  able  to  get  into  ready 
touch  with  the  mind  of  others,"  it  is  worth 
while  for  the  teacher  to  encourage  these  dis- 
cussions of  work.  All  handicrafts  go  back  far 
into  the  history  of  the  race,  and  are  connected 
with  every  phase  of  life.  An  interest  in  any 
one  of  them  must  be  wholesome,  even  if  they 
do  not  offer  fields  of  employment  to  the  handi- 
capped. 

The  work  of  the  occupation  teacher  fre- 
quently overlaps  that  of  the  teacher  of  re- 
educational  physical  exercises,  so  in  this  phase 
of  readjustment  the  physician  should  be  the 
one  responsible  for  every  step  taken.  In  cer- 
tain forms  of  paralysis,  for  instance,  manual 
work  often  aids  in  the  regaining  of  the  use  of 


94  THE  WORK  OF  OUR  HANDS 

the  affected  members,  but  as  the  work  given 
should  be  planned  in  relation  to  the  cause  of 
the  paralysis  it  should  be  prescribed  by  the 
physician.  In  some  cases  the  patient  needs  to 
be  encouraged  to  use  his  will,  to  get  control 
of  the  part  affected;  in  others,  the  less  con- 
sciously the  effort  is  made  the  more  beneficial 
the  effect.  Some  of  these  cases  will  be  taken 
up  in  detail  later  on.  In  general,  it  may  be 
said  that  therapeutic  manual  work  is  particu- 
larly helpful  in  the  treatment  of  all  physically 
handicapped  patients,  who  find  more  interest 
in  it  than  in  calisthenic  drills. 


IV 

ORGANIC  NERVOUS  DISEASES 

Tabes  (Locomotor  Ataccia) 

IN  order  to  thoroughly  test  the  value  of  oc- 
cupation work  for  those  suffering  from  organic 
nervous  diseases  it  is  essential  that  the  teacher 
have  the  opportunity  to  come  in  contact  with 
each  patient  for  a  long  period  of  time.  This 
is  not  often  possible,  as  the  patient  frequently 
changes  his  hospital  or  his  physician,  usually 
in  the  vain  hope  of  speedy  recovery.  Often, 
too,  such  cases  come  from  the  shifting  part  of 
the  population,  unskilled  laborers  accustomed 
to  working  wherever  they  can  get  a  job,  in 
the  habit  of  moving  often,  so  that  it  is  difficult 
to  keep  track  of  the  home  address.  The  na- 
ture of  certain  maladies  is  such  as  to  make  the 
victims  restless,  and  to  sap  their  ambition. 
Persons  crippled  by  accident  are  more  desir- 
ous to  become  self-supporting  than  those 
handicapped  by  disease.  There  are  certain  ail- 

95 


96  THE  WORK  OF  OUR  HANDS 

ments  which  tradition  has  credited  among  the 
ignorant  with  causing  a  slow  and  painful  death 
in  life.  Tabes  is  one  of  these.  As  a  matter 
of  fact,  however,  there  are  many  tabetic  men 
and  women  who  are  able  to  earn  a  good  liveli- 
hood, some  in  their  regular  avocations,  and 
others  in  new  ones,  adapted  to  meet  their 
changed  conditions.  The  discouragement  and 
restlessness  of  many  of  these  individuals  there- 
fore seems  to  be  partly  due  to  an  unnecessary 
lack  of  self-confidence. 

The  following  records  of  tabetic  patients  who 
have  been  under  observation  as  pupils  for  the 
last  six  years  show  what  good  work  can  be  done 
by  an  average  group  of  comparatively  helpless 
men  and  women,  all  past  middle  life,  and  in  a 
home  for  chronic  invalids.  They  have  good 
living  conditions,  simple  food,  regular  hours, 
and  cleanliness.  No  lessons  have  been  given  to 
reeducate  them  in  walking,  and  the  only  exer- 
cise most  of  them  have  had  is  that  incidental  to 
making  baskets,  caning  chairs,  etc.,  yet  only 
one  of  this  group  has  failed  markedly  in  the 
six  years;  on  the  other  hand,  they  are  all  able 
to  use  their  hands  better,  some  are  able  to  walk 
better,  and  all  have  a  better  mental  outlook 


BASKETRY  AND  WEAVING  DOXE  AT  BLOOMINGDALE 
HOSPITAL,  WHITE  PLAINS,  N.  Y. 


ORGANIC  NERVOUS  DISEASES  97 

owing  to  the  fact  that  they  are  able  to  work, 
that  their  lives  are  regulated  by  a  systematic 
routine,  and  that  they  have  broader  interests 
growing  out  of  their  common  tasks.  The 
teacher  of  this  group  found  constant  encour- 
agement necessary  at  first.  It  was  very  diffi- 
cult to  inspire  a  belief  in  future  efficiency. 
This  constant  optimistic  attitude  had  at  last 
a  distinct  therapeutic  effect.  Encouragement 
became  less  and  less  necessary  and  self-confi- 
dence returned. 

CASE  I.  Swede.  Male.  Age  50.  Elec- 
trical engineer. 

When  his  lessons  began  he  had  been  ill  five 
or  six  years;  had  gradually  become  unable  to 
walk  (on  entering  the  hospital  he  used  a  wheel 
chair),  thought  he  could  not  use  his  hands  for 
any  fine  work;  had  become  unnaturally  taci- 
turn; was  at  first  unwilling  to  try  to  make 
baskets,  as  he  called  this  "peasant's  work."  He 
soon  began  to  use  his  hands  freely  and  became 
very  proficient.  His  work  is  so  good  as  to  sell 
at  the  sales  of  the  National  Society  of  Crafts- 
men, and  he  has  learned  to  make  seventy-five 
distinct  styles  of  baskets.  Many  of  these  are 
variations  of  the  Swedish  birds'  nest  basket, 


98  THE  WORK  OF  OUR  HANDS 

flower  baskets,  etc.,  which  he  saw  in  his  youth. 
He  still  finds  walking  difficult,  and  while  he 
walks  two  miles  a  day  for  exercise  in  the  corri- 
dors in  the  hospital  he  keeps  one  hand  on  his 
wheel  chair,  pushing  it  in  front  of  him.  He 
cannot  use  a  hammer  or  saw,  or  do  any  work 
requiring  much  strength,  but  his  lower  arms 
and  hands  are  entirely  under  control,  and  he 
has  resumed  the  study  of  the  violin,  which  he 
had  been  unable  to  play  for  many  years,  and 
plays  with  great  delicacy.  He  is  able  to  do 
mechanical  drawing  again,  and  is  in  hopes  after 
twelve  years  of  invalidism  to  take  a  residential 
position  in  a  school  to  teach  draughting  and 
manual  training. 

CASE  II.  Colored.  Male.  Age  36.  Car- 
penter. 

Was  in  bed  nine  months  before  industrial 
treatment  began.  At  that  time  he  was  up  and 
beginning  to  walk,  but  with  much  fear  of  fall- 
ing; said  he  was  unable  to  walk  at  all  without 
a  cane;  could  not  use  hands  well;  had  difficulty 
in  dressing  himself;  he  welcomed  with  eager- 
ness the  chance  to  try  some  basketry,  but  could 
not  make  reed  baskets.  After  some  experi- 
menting the  teacher  found  he  could  use  very 


ORGANIC  NERVOUS  DISEASES  99 

fine  materials  and  do  raffia  work  sewed  with  a 
needle  (like  Indian  basketry),  but  he  could 
not  thread  a  needle,  nor  pick  it  up  in  case  he 
dropped  it.  He  had,  however,  a  great  degree 
of  persistency,  and  natural  courage.  He  soon 
got  control  of  his  materials,  although  he  says 
he  still  has  no  feeling  in  his  fingers,  but  that 
he  has  learned  to  "manage  without  it."  His 
work  is  artistic  in  color,  and  the  designs  are 
worked  out  very  accurately.  His  baskets  are 
sold  by  the  National  Society  of  Craftsmen  for 
from  $5  up.  He  is  able  to  do  fine  work  as 
his  eyesight  has  remained  good.  He  is  be- 
ginning to  use  his  arms,  and  is  trying  chair 
caning  to  get  control  of  the  upper  arm.  He 
tried  weaving,  but  could  not  prevent  the 
threads  tangling  because  of  the  numbness  of 
his  fingers.  He  walks  better,  but  sometimes 
falls.  He  had  formerly  a  good  singing  voice. 
For  two  or  three  years  he  could  not  control  it, 
and  it  was  harsh,  discordant,  but  the  quality 
has  returned,  and  he  is  able  to  control  it  well 
enough  to  sing  in  a  choir. 

CASE  III.  Colored.  Male.  Age  50. 
Nearly  white,  part  Irish. 

"Handy  Man"  who  never  had  a  trade;  had 


100  THE  WORK  OF  OUR  HANDS 

been  ill  five  or  six  years;  walked  with  great 
difficulty  and  preferred  to  use  wheel  chair. 
Had  frequent  attacks  of  indigestion  and  spent 
nearly  half  his  time  in  bed  in  great  pain. 
Very  irritable  and  quarrelsome,  no  interest  in 
life,  no  mental  resources,  convinced  in  his  own 
mind  that  "he  could  never  be  any  good."  Re- 
fused to  try  any  occupation  work,  until  he  saw 
other  patients  sell  work.  As  soon  as  he  began 
to  work  he  became  interested.  His  work  at 
first  was  crude,  his  hands  were  not  under  his 
control.  He  soon  began  to  develop  originality, 
and  on  his  bad  days  lay  in  bed,  and  planned 
what  he  would  do  when  he  got  up.  His  prog- 
ress toward  good  work  was  very  slow  but  he 
can  now  do  both  basketry  and  chair  caning. 
He  makes  very  large,  coarse  raffia  baskets,  very 
substantial  and  decorated  with  animals  in 
quaint  designs,  owls,  parrots,  bluebirds,  and 
even  bulls  and  deer.  He  can  sell  all  he  can 
make  at  $4  each.  His  eyes  are  very  defective; 
he  walks  badly,  but  he  is  happy  in  his  work,  in 
fact,  his  nature  has  changed  considerably  for 
the  better.  Previous  to  this  time  he  had  no 
opportunity  to  learn  any  work  that  was  either 
interesting,  or  well  paid,  and  he  has  also  an 


ORGANIC  NERVOUS  DISEASES  101 

artistic  instinct  which  never  "had  the  'opjpor-' 
tunity  of  expression.  He  is  able  to  buy  his 
own  clothing,  and  to  pay  his  own  carfare  for 
short  visits  to  his  friends,  and  gets  great  sat- 
isfaction in  not  being  entirely  an  object  of 
charity. 

CASE  IV.  Englishman.  Age  49.  Cab- 
inet-maker. 

Had  been  in  hospital  one  year;  walked  very 
badly,  and  had  trouble  with  his  eyesight ;  could 
not  lift  a  heavy  hammer,  nor  control  his  arm 
to  drive  a  nail.  He  was,  however,  able  to  learn 
to  weave  on  a  hand-loom  very  quickly,  and  had 
no  difficulty  except  in  threading  it.  His  work 
was  salable  from  the  first.  He  also  learned 
reed  basketry,  and  filled  an  order  for  five 
dozen  baskets  from  a  florist.  He  was  very 
easily  discouraged  and  his  lack  of  control  of 
his  fingers  exasperated  him.  His  threads  be- 
came tangled  in  weaving,  and  he  fumbled  with 
his  basket  materials.  He  constantly  compared 
his  former  skill  with  his  present  inefficiency. 
He  recovered  the  use  of  his  hands  somewhat, 
and  was  able  to  do  part  time  work  on  the 
switch-board  as  telephone  operator,  and  he  also 
walked  better  so  that  he  could  act  as  a  mes- 


102  THE  \TOBK  OF  OUR  HANDS 

senger  for  the  hospital,  as  well  as  do  indus- 
trial work.  Later  he  had  a  general  break- 
down, and  is  just  recovering  after  several 
months  in  the  hospital  ward.  He  walks  well. 

CASE  V.  Light,  or  "bright-skinned"  col- 
ored woman,  with  some  Indian  blood.  Age  60. 

When  lessons  began  she  had  been  ill  five  or 
six  years;  walked  with  difficulty  with  a  cane. 
Hands  jerked  when  she  attempted  to  move 
them.  Very  irritable  temper;  complained  of 
her  eyes  troubling  her  and  of  headache ;  willing 
to  learn  basketry  because  she  was  under  ob- 
ligations to  several  people  to  whom  she  would 
like  to  make  a  present.  She  became  interested 
at  once,  and  showed  great  persistency,  and 
some  color  sense;  had  difficulty  in  controlling 
her  hands,  but  work  on  a  small  hand-loom 
seemed  to  help  her  regain  control  of  them. 
She  has  never  shown  much  originality,  but  her 
work  is  exceptionally  firm  in  quality,  and  she 
has  better  control  of  her  hands,  but  cannot  do 
fine  sewing.  She  walks  about  the  same  as 
ever,  using  a  cane.  Her  work  has  been  of 
great  benefit  socially,  as  it  keeps  her  happily 
occupied,  and  affords  her  a  means  of  working 


ORGANIC  NERVOUS  DISEASES  103 

off  her  irritability  on  an  inanimate  object  in- 
stead of  on  her  neighbors. 

CASE    VI.     German-American.     Age    43. 
Pianist  in  music  halls. 

Eyesight  very  poor,  willing  to  try  basket- 
weaving  as  a  curative  measure,  but  not  in- 
terested in  craft  work  for  its  own  sake. 
Thought  he  could  not  learn  basketry  or  chair 
caning,  after  trying  for  some  weeks,  as  he  said 
he  became  confused  when  he  looked  at  the 
work.  (This  was  soon  after  the  onset  of  his 
illness  and  he  was  depressed,  and  self- 
centered.)  The  teacher  concluded  he  might 
be  helped  through  interest  in  other  invalids, 
and  got  him  to  play  ball  with  child  patients. 
He  soon  learned  to  use  his  hands  and  arms 
sufficiently  to  play  ball  with  a  soft,  large  rub- 
ber ball.  After  this  he  was  taught  to  cut  out 
pictures  to  make  a  scrap-book  for  child  pa- 
tients. He  had  difficulty  in  holding  scissors 
at  first,  but  finally  succeeded,  and  learned  also 
to  cut  accurately  and  to  eventually  manage 
pasting.  As  he  regained  the  use  of  his  hands, 
he  wished  to  try  to  practice  on  the  piano,  and 
permission  was  obtained  for  him.  He  was 


104  THE  WORK  OF  OUR  HANDS 

very  slow  in  getting  control  of  his  fingers,  but 
this  may  have  been  partly  due  to  lack  of  con- 
fidence, as  his  depression  was  so  extreme  as 
to  seem  almost  like  melancholia.  His  atten- 
tion was  fixed  on  his  own  condition,  and  he 
was  sure  he  would  never  be  any  better.  Dur- 
ing a  gastric  crisis  he  attempted  suicide  by  try- 
ing to  jump  from  a  fourth  floor  window. 
However,  these  symptoms  disappeared  as  he 
became  able  to  play  again,  and  to  get  about 
the  streets.  He  never  recovered  his  courage 
sufficiently  to  attempt  to  walk  in  the  street, 
and  goes  about  on  a  tricycle.  He  is  able  to 
fill  some  professional  engagements,  and  if 
necessity  forced  him  to  depend  entirely  upon 
himself  he  could  probably  do  so.  It  might 
be  better  for  him  if  he  had  to  support  himself. 
These  six  cases  are  selected  from  eighteen 
or  twenty  taught  for  the  same  length  of  time 
as  showing  average  results.  The  choice  of 
work  was  necessarily  limited,  for  attempts  at 
heavier  work  proved  that  it  would  be  useless 
to  try  anything  requiring  much  physical 
strength.  Not  one  of  these  patients  can  as 
yet  handle  a  hammer. 


ORGANIC  NERVOUS  DISEASES  105 

CASE  VII.  American.  Age  52.  Country 
merchant  (small  notion  store). 

This  man  kept  at  work  until  his  illness  was 
so  severe  that  he  was  often  confined  to  his  bed. 
Some  of  his  wealthy  customers  formed  a  com- 
mittee to  help  him  dispose  of  his  property, 
which  he  did,  investing  the  proceeds,  a  few 
hundred  dollars,  so  the  interest  would  help  pay 
the  bills  of  his  two  children  in  a  semi-private 
"home."  He  was  admitted  to  the  county 
home  on  condition  that  he  be  allowed  a  pass  to 
go  out  to  peddle  small  wares  through  the 
country  in  the  summer.  After  he  had  tried 
this  two  summers  he  was  sent  to  the  clinic  with 
the  suggestion  that  he  learn  chair  caning  to  do 
in  the  winter,  when  he  could  not  go  out.  His 
eyesight  was  not  good,  and  he  worked  awk- 
wardly, but  anyway  his  inattention  and  lack  of 
interest  would  have  prevented  his  becoming 
proficient.  He  openly  said  that  he  had  plenty 
of  friends  to  help  him,  and  that  he  did  not  care 
to  bother  to  learn  anything  new.  He  could 
walk  quite  well,  and  tried  to  avoid  going  out 
wet  days,  so  that  the  exercise  seemed  likely 
to  be  good  for  him,  but  the  next  summer  he 


106  THE  WORK  OF  OUR  HANDS 

lost  many  customers,  perhaps  because  of  the 
fact  that  he  had  begun  to  trade  on  his  in- 
firmities and  try  to  arouse  sympathy.  He 
asked  for  food  from  farmers'  wives,  and  ate 
irregularly.  He  also  began  to  frequent 
country  taverns  and  to  drink,  on  the  ground 
that  walking  tired  him  so  much.  His  charac- 
ter, in  fact,  seemed  to  deteriorate,  much  to  the 
surprise  of  the  committee  which  had  devised 
this  plan  of  keeping  him  self-supporting.  He 
finally  became  so  intemperate  that  his  "pass" 
to  go  out  was  revoked.  During  the  ensuing 
winter  he  died  of  so-called  heart  failure. 

There  have  been,  however,  a  considerable 
number  of  patients  with  locomotor  ataxia,  who 
have  been  under  treatment,  and  who  have 
been  able  to  earn  a  modest  livelihood.  One 
was  a  stenographer,  who  had  to  give  up  her 
position,  and  take  an  easier  one  with  shorter 
hours.  In  spite  of  her  complaint  that  her 
finger  tips  were  numb,  she  has  been  able  to  do 
successful  work  for  about  three  years.  An- 
other stenographer  gave  up  her  stenographic 
work  to  become  an  interpreter. 

A  re-toucher  in  a  photographic  studio  gave 
up  his  special  line  to  do  more  general  work 


ORGANIC  NERVOUS  DISEASES  107 

in  outdoor  photography.  The  change  of 
scene  proved  beneficial  in  keeping  him  from 
worrying,  and  the  outdoor  air  and  exercise  also 
helped  him. 

Many  more  instances  could  be  cited  of  per- 
sons who  have  been  able  to  remain  self-sup- 
porting, and  of  others  who  have  become  so 
after  a  period  of  illness,  but  it  must  be  ad- 
mitted that  strength  of  character  is  required 
for  a  tabetic  man  or  woman  to  keep  the  poise 
and  self-confidence  necessary  to  bear  the  pain 
and  discouragement  incidental  to  the  illness, 
and  at  the  same  time  work  for  a  living. 

Work  is  sometimes  interrupted  for  days 
and  even  weeks  by  attacks  of  severe  pain,  and 
fits  of  depression.  Gloomy  weather  often  de- 
presses tabetic  patients,  and  the  difficulties  of 
locomotion  seem  to  be  greater  at  such  times. 

Usually  the  depression  becomes  less  after  a 
time,  and  the  intervals  of  awkwardness  less 
frequent  as  the  patient  gets  better  control  of 
his  hands,  so  that  any  teacher  starting  work 
with  tabetic  patients  can  honestly  encourage 
them  in  the  hope  of  years  of  usefulness,  within 
moderate  limits.  The  process  of  reeducation 
is  a  tiresomely  long  one,  and  the  sticking  to 


108  THE  WORK  OF  OUR  HANDS 

routine  is  a  severe  trial  to  those  in  whom  the 
work-habit  has  been  lost,  so  that  much  re- 
sponsibility at  first  devolves  on  the  teacher. 

Disseminated  Sclerosis 

There  are  several  organic  diseases  of  the 
central  nervous  system,  in  which  the  use  of  the 
hands  is  lost  or  impaired.  As  these  are  de- 
generative diseases,  their  progress  may  be  but 
slightly  stayed  by  any  therapeutic  occupation 
and  it  would  be  in  many  cases,  an  unkindness 
to  encourage  patients  to  look  forward  to  doing 
remunerative  craft  work.  Practice  gives  but 
little  increase  in  skill,  although  occupation 
work:  frequently  adds  much  to  happiness. 
Special  attention  is  given  here  to  this  class  of 
patients,  as  these  diseases  are  becoming  more 
common  (or  more  promptly  recognized)  and 
patients  suffering  from  them  are  liable  to  ap- 
pear before  almost  any  occupation  teacher. 
These  comparatively  unfamiliar  diseases  offer 
a  new  field  for  study  and  in  many  instances 
the  possibility  of  new  forms  of  gainful  occupa- 
tion. Few  of  them  affect  the  mind,  and  men- 
tal resources  may  sometimes  be  cultivated  in 


ORGANIC  NERVOUS  DISEASES  109 

many  who  could  never  become  expert  in  ap- 
plied art. 

Among  twenty  patients  taught,  not  one  has 
done  really  good  work,  although  most  of  them 
have  been  young  men  and  women  of  intelli- 
gence, interested  in  their  work.  The  effort  to 
use  the  hands  almost  always  caused  so  much 
tremor  that  good  work  could  not  be  done. 
This  "intention  tremor"  increased  as  an  at- 
tempt was  made  to  raise  the  hands  high  enough 
to  do  basketry  or  other  hand  work,  and  it  did 
not  yield  to  the  control  of  the  will,  even  when 
the  habit  of  work  was  well  established.  Some 
patients  were  distressed  and  disheartened  by 
it,  others  simply  took  it  as  a  matter  of  course, 
and  tried  to  work  in  spite  of  it.  Defective 
eyesight  also  made  work  difficult,  the  princi- 
pal complaint  being  of  dimness  of  vision. 
Some  patients  said  they  could  see  nothing  but 
objects  directly  in  front  of  them.  Some  of 
these  patients  walked  well,  others  with  great 
difficulty,  and  some  not  at  all  at  times.  It  is 
interesting  to  note  that  most  of  these  were 
ordered  occupation  work  by  their  physicians 
and  that  they  took  a  normal  interest  in  the 


110  THE  WORK  OF  OUR  HANDS 

work,  in  spite  of  their  comparatively  poor  suc- 
cess. One  or  two  were  depressed,  others  were 
inclined  to  fits  of  giggling  which  seemed  to 
surprise  and  embarrass  them.  Speech  was  sel- 
dom under  control,  rhythmic  inflections  like 
scanning  of  poetry  preventing  natural  expres- 
sion. 

Several  persons  have  come  under  the  writer's 
observation  who  were  particularly  interesting, 
and  worth  individual  description. 

CASE  I.  American.  Age  30.  School 
teacher. 

This  young  lady  had  become  suddenly  ill 
six  years  before  and  spent  most  of  her  time  in 
a  wheel-chair.  She  hoped  to  be  able  to  fit  her- 
self as  a  manual  training  teacher,  and  take  a 
residential  position  as  her  peculiar  speech  pre- 
vented ordinary  teaching.  She  made  every  ef- 
fort to  succeed  in  manual  work,  trying  first 
basketry,  then  book-binding  and  then  knitting. 
In  basketry  her  greatest  trouble  seemed  to  be 
her  sight,  the  reeds  confusing  her.  Raffia 
basketry  was  even  harder,  as  she  could  not 
pull  the  thread  tight.  Folding  paper  for  book- 
binding troubled  her,  and  she  could  not  see  to 
sew  the  sections  together.  Typewriting  was 


ORGANIC  NERVOUS  DISEASES  111 

also  unsuccessful.  After  several  weeks  her 
physician  sent  her  home  from  the  hospital. 

CASE  II.     Italian  girl.     Age  20. 

This  girl  had  become  ill  gradually;  she 
could  walk  (slowly),  but  could  not  stand 
long,  and  her  speech  was  poor.  These  con- 
ditions prevented  her  doing  shop  or  factory 
work,  and  as  the  family  needed  money,  it  was 
necessary  for  her  to  find  something  adapted 
to  her  peculiar  limitations.  After  various 
trials  it  was  found  that  she  had  good  taste 
in  color  and  could  learn  coarse  embroidery. 
She  does  Bulgarian  embroidery  for  a  fancy 
goods  store,  and  is  greatly  pleased  with  her 
work.  At  last  reports  her  general  health  was 
about  the  same,  after  three  years. 

CASE  III.  American.  Male.  Age  28. 
Designer. 

This  young  man  was  a  designer  of  pottery 
and  of  advertising  posters.  He  was  ill  for 
three  years,  during  one  year  of  which  he  was 
unable  to  walk  or  use  his  hands.  He  grad- 
ually recovered  the  power  of  locomotion,  but 
his  hands  and  eyesight  are  not  quite  the  same. 
He  earns  his  living  at  present  as  critic  of  the 
advertising  work  submitted  to  a  large  bus- 


112  THE  WORK  OF  OUR  HANDS 

iness  concern,  and  is  thus  able  to  make  use  of 
his  art  knowledge  without  depending  on  the 
use  of  his  hands. 

One  woman  who  is  the  mother  of  a  family 
is  able  to  superintend  her  house,  and  another 
young  woman  unable  to  walk,  does  much  of 
the  family  cooking.  Men  seem  to  be  at  more 
of  a  loss  than  women  to  adapt  themselves  to 
the  peculiar  conditions  imposed  by  this  dis- 
ease. Those  who  can  walk  seem  to  get  satis- 
faction from  bodily  exercises.  One  young 
man  said  running  the  printing  press  "lim- 
bered him  up,"  another  found  carpentry 
helped  him  in  muscular  coordination. 

Chair  caning  seemed  a  promising  form  of 
occupation  work,  as  the  frame  afforded  a 
guide  for  the  hands.  Both  women  and  men 
patients  succeeded  in  it.  Basketry  was  not 
generally  well  done,  although  it  seemed  to 
arouse  interest.  Sewing  was  generally  un- 
satisfactory, coarse  knitting  fairly  good,  but 
none  of  these  occupations  gave  real  control  of 
the  hands  such  as  tabetics  gain  from  hand 
work.  Cement  work  might  afford  such  pa- 
tients a  means  of  livelihood,  where  weaving, 
basketry,  etc.,  would  be  too  difficult. 


ORGANIC  NERVOUS  DISEASES  113 

Syringomyelia 

Several  patients  with  this  disease  were 
taught,  all  about  alike  in  their  inability  to  use 
the  hands  freely,  the  fingers  being  numb, 
stiff,  and  drawn  up,  and  the  thumb  and  fore- 
finger sometimes  unable  to  grasp  anything. 

CASE  I.    Austrian.    Art  student.    Age  20. 

This  young  man  had  been  earning  his  liv- 
ing day  times  and  studying  art  in  night  school 
for  three  years  previous  to  his  illness.  He 
had  become  tired  out  and  came  to  the  hospital 
to  find  out  what  ailed  him,  as  at  times  he 
could  hardly  walk.  He  grew  worse,  but  still 
thought  he  must  earn  his  living,  and  as  his 
study  of  art  had  given  him  knowledge  of  de- 
signing, he  found  a  firm  for  whom  he  could 
design  monograms  at  home.  His  work  at 
first  was  excellent,  as  he  had  good  color  sense, 
and  originality,  but  he  worked  very  slowly, 
and  with  great  effort.  After  a  few  weeks  he 
became  unable  to  "feel  the  paint  brush"  as 
he  expressed  it,  and  his  fingers  began  to  curl 
in.  His  right  hand  only  was  affected,  and  he 
might  have  in  time  learned  to  work  with  his 
left  hand,  but  his  general  health  began  to 


114  THE  WORK  OF  OUR  HANDS 

grow  worse,  and  he  went  to  a  home  for  in- 
curables. 

Chronic  Myelitis 

Among  several  patients  taught,  one  shows 
what  can  be  accomplished  with  work  exactly 
graded  to  the  ability  of  the  individual  with 
this  disease. 

An  Italian  about  25,  gifted  with  a  keen 
sense  of  color  and  good  taste,  felt  it  necessary 
to  keep  on  working.  He  had  very  little  phys- 
ical strength  and  could  not  do  any  heavy 
work,  but  finally  learned  to  make  delicate  lit- 
tle baskets  to  hold  bonbons,  or  nuts,  which  a 
fruiterer  was  glad  to  buy.  His  problem 
seems  to  have  been  solved  satisfactorily  as  he 
is  happy,  able  to  put  his  talents  to  use  through 
his  artistic  ability,  and  earn  a  modest  liveli- 
hood, without  any  danger  of  bodily  or  mental 
exhaustion. 

Poliomyelitis 

This  disease  has  become  so  common  among 
children  that  it  is  not  necessary  to  report  in- 
dividual cases,  the  methods  used  in  treatment 
being  well  known.  Generally  speaking,  man- 


ORGANIC  NERVOUS  DISEASES  115 

ual  work  given  should  be  such  as  to  bring  the 
whole  body  into  a  normal  activity,  with  some 
special  work  in  case  the  physician  orders  it, 
for  the  parts  most  affected.  Carpentry  work, 
chair  caning,  basketry,  and  weaving  are  in- 
teresting to  children,  and  require  the  use  of 
both  hands.  If  carpentry  and  weaving  are 
well  taught,  so  that  the  child  holds  himself  in 
a  good  position  while  at  work,  they  are  ex- 
cellent exercises  for  the  whole  body.  Chil- 
dren in  bed  frequently  work  in  awkward  and 
strained  positions,  and  care  should  be  exer- 
cised by  the  teacher  to  give  very  light  work  at 
first,  and  get  the  child  into  the  habit  of  work- 
ing in  a  natural  position.  Cutting  out  pic- 
tures may  precede  any  real  manual  work. 
Spool  knitting  is  interesting  to  very  small 
children.  Making  braided  or  chain  stitch 
horse  reins  of  coarse  cord  is  good  work  also. 
Adults  taught  were  most  interesting;  one  was 
able  to  get  considerable  physical  benefit  from 
doing  heavy  basketry,  although  she  sat  in  a 
wheel-chair.  Making  scrap  baskets  gave 
good  exercise  to  the  whole  upper  part  of  the 
body.  She  also  did  coarse  knitting,  her  phy- 
sician having  ordered  that  she  do  as  heavy 


116  THE  WORK  OF  OUR  HANDS 

work  as  was  convenient  in  her  cramped  posi- 
tion. Another  patient  who  was  able  to  walk, 
ran  the  printing  press  two  hours  a  day,  print- 
ing several  hundred  treatment  cards. 

Paralysis  Caused  by  Accidents 

Among  the  most  interesting  patients  taught 
were  some  who  had  become  crippled  by  ac- 
cident so  as  to  lose  the  use  of  the  lower  part 
of  the  body. 

CASE  I.  American.  Colored  woman.  Age 
40.  Cook. 

This  woman  fell  on  the  ice  and  injured  her 
spine.  After  being  unable  to  walk  for  eight- 
een months,  she  could  not  stand  any  length 
of  time.  This  of  course  prevented  her  re- 
suming her  ordinary  work.  She  could  not 
learn  to  become  a  good  sewer,  and  the  teacher 
finally  decided  to  try  her  on  very  light  laun- 
dry work,  which  can  be  done  sitting  (doing 
up  lace,  lingerie,  waists,  fine  underwear,  etc.). 
A  domestic  science  teacher  gave  her  six  les- 
sons, after  which  she  returned  to  her  home 
in  the  South  and  is  earning  a  good  living  at 
this  work. 


ORGANIC  NERVOUS  DISEASES  117 

CASE  II.  Bohemian.  Age  30.  Hod- 
carrier. 

This  man  was  very  ignorant,  and  after  his 
accident  (a  fall  from  a  building)  he  lay  for 
a  long  time  in  a  kind  of  stupor,  as  no  one  in 
the  hospital  could  speak  his  language,  and  he 
was  too  discouraged  to  try  to  rouse  himself; 
he  was  finally  put  in  a  wheel  chair  and  found 
he  could  sit  up.  He  was  given  the  opportu- 
nity to  learn  chair-caning.  He  at  once  became 
enthusiastic,  and  evinced  a  dexterity  quite  re- 
markable in  one  who  had  never  done  any 
skilled  work  before.  He  has  now  taken  up 
the  making  of  reed  tea  trays,  and  is  rapidly 
becoming  expert.  He  could  probably  earn 
more  now,  after  one  year's  training,  than  he 
ever  earned  when  he  had  his  full  bodily 
strength. 

CASE  III.     Irishman.     Age  25.     Hostler. 

This  man  injured  his  spine  by  a  fall  from 
a  horse.  He  sat  in  a  wheel  chair.  He  was 
liable  to  be  deported,  and  work  had  to  be 
chosen  which  he  could  do  in  Ireland,  if  he 
went  back  to  a  small  village.  A  cobbling 
teacher  was  engaged  for  him  and  it  was  found 


118  THE  WORK  OF  OUR  HANDS 

that  he  could  learn  to  put  on  patches,  and 
mend  soles,  but  not  to  make  new  shoes,  as  he 
could  not  bear  so  much  pressure  on  his  knees. 

Caisson  Disease 

CASE  IV. 

Two  most  interesting  cases  of  this  form  of 
paralysis  were  taught. 

The  first  one  was  a  worker  in  the  Hudson 
Tunnels,  who  had  been  crippled  for  two  years. 
The  occupation  work  given  at  first  was  of  the 
lightest  order,  and  he  used  his  hands  awk- 
wardly. His  strength  gradually  became 
greater,  until  he  ended  his  work  cure  by  paint- 
ing the  walls  of  a  room,  part  of  the  time 
standing  on  a  ladder. 

The  second  was  also  a  tunnel  worker,  who 
was  brought  as  an  emergency  case  to  the  hos- 
pital. As  soon  as  he  was  able  to  use  his 
hands,  he  asked  for  work,  and  began  basketry 
before  he  could  walk  at  all  well.  He  seemed 
to  derive  much  benefit  from  weaving  rag  rugs 
on  a  very  heavy  loom.  Both  these  men  ex- 
pressed particular  satisfaction  in  doing  heavy 
work  requiring  the  use  of  all  parts  of  the  body. 


ORGANIC  NERVOUS  DISEASES  119 

The  second  is  now  on  night  duty  in  a  hospital 
ward  where  he  has  to  do  much  lifting  of  pa- 
tients, and  continues  to  improve. 


V 

HYSTERIA 

AMONG  the  diseases  which  seem  to  derange 
the  whole  system,  altering  character,  at  least 
temporarily,  and  interfering  with  the  activi- 
ties of  the  body,  hysteria  has  a  place  all  its 
own.  How  much  occupation  can  do  to  help 
an  individual  so  afflicted  is  still  an  open  ques- 
tion. In  most  of  the  cases  here  recorded,  oc- 
cupational treatment  has  been  kept  up  for 
several  months.  Results  have  been  compara- 
tively poor  and  difficult  to  obtain.  It  is  prob- 
able, however,  that  the  patient  can  by  system- 
atic work  and  keeping  the  attention  centered 
on  immediate  ends  to  be  accomplished  day- 
by-day,  partially  control  the  manifestations  of 
the  disease.  Whether  such  "assuming  a  vir- 
tue if  you  have  it  not"  can  bring  about  a  final 
cure  is  doubtful.  Work  certainly  holds  the 
patient  to  a  purpose,  and  it  would  appear  that 
it  might  ward  off  violent  attacks,  as  in  the 

120 


HYSTERIA  191 

present  series  a  hysterical  patient  has  never 
had  an  attack  further  than  a  fit  of  trembling 
which  usually  stopped  as  soon  as  the  attention 
was  again  centered  on  the  work.  Paralysis 
of  the  hands  sometimes  hindered  work,  and 
sometimes  the  patient  unconsciously  used  a 
hand  while  working,  which  seemed  to  be  help- 
less at  other  times.  Curiously  enough,  the 
workmanship  of  every  hysterical  patient  was 
of  a  high  order,  in  spite  of  apparent  paralysis, 
rigidity,  etc.  Neatness  and  exactness  seemed 
to  be  a  matter  of  pride,  even  where  the  patient 
would  admit  no  interest  in  the  work.  There 
was  almost  always  also  considerable  artistic 
ability,  the  general  standard  being  high.  It 
might  be  supposed  that  such  clever  workers 
would  be  easy  to  teach;  on  the  contrary,  they 
were  very  difficult,  as  most  of  them  accom- 
plished nothing  in  group  work.  This  seemed 
due  to  the  proximity  of  others,  rather  than  the 
need  of  individual  teaching,  as  the  same  pa- 
tients could  work  well  alone  in  a  room.  As 
a  rule  they  were  but  little  interested  in  the 
work  of  other  patients  unless  the  interest  was 
rather  forced  upon  them. 

Individual  teaching,  however,  was  satisfac- 


122  THE  WORK  OF  OUR  HANDS 

tory,  after  the  patients  had  become  used  to  the 
condition;  at  first  they  seemed  often  puzzled 
by  their  own  lack  of  interest,  and  difficulty  of 
concentration.  It  may  be  observed  that  the 
method  used  was  a  simple  appeal  to  the  sense 
of  sight  and  touch  in  making  work  that  looked 
attractive  and  useful,  and  was  pleasant  to 
work  on.  The  amount  of  work  was  increased 
gradually,  also  the  degree  of  intricacy  and 
originality,  but  it  was  never  necessary  to  be- 
gin with  childish  work.  After  a  short  time 
the  patients  found  no  difficulty  in  doing  fine 
embroidery,  tatting  and  other  intricate  work, 
and  seldom  complained  of  fatigue.  They 
were  often  difficult  to  manage,  capricious,  and 
sometimes  irritable.  Wherever  possible  the 
hysterical  patients  were  given  large  work,  re- 
quiring use  of  all  parts  of  the  body,  but  this 
was  usually  beyond  their  ability  at  first. 
When  it  became  possible,  large  heavy  work, 
like  weaving  or  carpentry,  seemed  especially 
beneficial  in  holding  the  attention,  giving 
good  muscular  coordinations  and  affording 
an  outlet  for  the  constructive  imagination. 
Group  work  was  beneficial  when  the  patient 


HYSTERIA  123 

had  got  to  the  point  of  a  normal  interest  in 
other  people. 

A  few  cases  are  reported  to  show  individual 
peculiarities. 

CASE  I.    American  woman.     Age  30. 

Had  been  an  invalid  for  eight  or  nine  years 
and  during  all  that  time  had  thought  she  could 
not  walk.  Was  under  treatment  by  a  physi- 
cian who  succeeded  after  eighteen  months  in 
relieving  her.  Her  occupation  work  was  at 
first  entirely  individual  in  her  room,  was  much 
interrupted  by  fits  of  trembling,  talk  about 
her  inability  to  work,  etc.  It  took  a  whole 
winter  to  make  one  sewed  basket  and  one  em- 
broidered waist,  both  exquisitely  done,  after 
which  she  seemed  to  have  a  sudden  releasing 
of  energy  and  worked  willingly  and  efficiently, 
and  enjoyed  group  work.  After  her  return 
home  she  not  only  applied  all  she  had  learned 
in  her  own  work,  but  also  made  use  of  much 
knowledge  she  had  picked  up  by  watching 
other  patients,  and  is  constantly  occupied  in 
doing  really  beautiful  craft  work. 

CASE  II.  American  woman.  Age  40. 
Pianist. 


124  THE  WORK  OF  OUR  HANDS 

This  lady  had  a  sudden  attack  which 
seemed  like  a  stroke  of  paralysis,  after  which 
she  could  scarcely  walk,  and  could  not  use 
the  left  hand.  She  soon  began  to  gain  except 
in  the  dragging  of  one  foot  but  was  still  un- 
able to  use  her  paralyzed  hand,  which  caused 
her  much  anxiety  as  she  had  to  earn  her  liv- 
ing as  a  pianist.  She  tried  to  use  the  type- 
writer with  her  left  hand  but  was  unable  to 
strike  the  keys  with  sufficient  force  to  make 
any  impression  unless  she  was  alone  in  the 
room,  and  even  then  could  not  control  the  in- 
dividual fingers.  At  times  her  fingers  worked 
fairly  well  for  a  few  minutes.  This  patient 
was  not  interested  in  manual  work,  and  the 
teacher  thought  it  would  be  better  for  her 
to  devote  her  time  to  piano  practice.  She 
seemed  suggestible  and  her  physician  and  the 
teacher  kept  before  her  attention  the  thought 
that  the  use  of  her  hand  depended  on  her  own 
efforts.  As  soon  as  she  fixed  her  attention 
on  this  one  thing,  she  began  to  practice  on 
the  piano  steadily,  three  or  four  hours  a  day, 
a  half  hour  at  a  time;  concentrating  her  at- 
tention on  one  thing  seemed  to  help  her,  as 
she  not  only  slowly  regained  the  use  of  her 


HYSTERIA  125 

hand,  but  her  inability  to  walk  seemed  to  leave 
of  itself.  She  seemed  to  forget  all  about  it. 
At  last  reports  she  was  able  to  resume  her 
work. 

CASE  III.    American  woman.    Age  25. 

This  young  lady  had  mastoiditis  when  she 
was  twenty,  and  afterwards  became  a  semi- 
invalid;  at  one  time  thought  she  had  flat-foot 
and  could  hardly  walk.  About  two  years  ago 
she  decided  she  could  not  do  her  hair  up  as 
her  scalp  was  sensitive.  This  prevented  her 
going  into  society,  and  she  became  a  kind  of 
recluse,  living  mostly  in  her  bedroom.  She 
took  up  basketry  at  home,  and  worked  with 
great  success  as  far  as  technique  was  con- 
cerned, but  her  capriciousness  made  her  a  dif- 
ficult pupil.  Some  days  she  complained  of 
dimness  of  vision,  and  acted  as  if  she  could 
hardly  see,  until  she  became  interested,  when 
she  worked  splendidly.  She  ruled  her  own 
affairs  entirely,  as  her  family  had  given  up 
trying  to  control  her.  She  would  have  no 
physician,  and,  in  fact,  looked  well  to  the  cas- 
ual observer,  so  that  her  people  did  not  urge 
her  to  put  herself  under  medical  care.  She 
was  very  unhappy,  and  it  seemed  pitiful  that 


126  THE  WORK  OF  OUR  HANDS 

the  best  years  of  her  life  should  be  wasted,  so 
she  was  urged  to  go  to  a  neurologist,  who  put 
her  in  the  hospital.  Singularly  enough,  she 
evinced  the  same  trait  shown  by  other  hysteria 
patients  of  being  unable  to  do  group  work, 
although  she  had  been  so  successful  in  bas- 
ketry at  home.  However,  she  took  up  knit- 
ting in  her  room,  and  took  some  interest  in 
it.  Her  physician  estimated  that  her  recov- 
ery would  take  at  least  eighteen  months 
longer,  the  first  few  of  which  are  being  spent 
in  a  sanatorium,  in  the  country  where  she 
leads  an  active  outdoor  life. 

CASE  IV.  Italian- American.  Male.  Age 
12.  School-boy. 

This  boy  was  in  the  hospital  first  for 
chorea,  and  was  isolated  for  a  few  weeks.  He 
was  ordered  occupation  work  as  soon  as  the 
twitchings  allowed,  and  became  at  once  en- 
thusiastic, doing  excellent  basketry  and  chair- 
caning,  and  evincing  intelligent  interest  in  the 
work  of  others.  He  went  home  cured.  A 
year  later  he  returned  to  the  hospital,  and  the 
teacher  naturally  expected  him  to  resume  his 
former  interest,  but  far  from  it.  His  nature 
was  altered,  he  worked  only  when  urged  to 


HYSTERIA  127 

and  then  ungraciously,  paying  no  attention 
to  what  others  were  doing.  This  time  he 
made  only  a  brief  visit  to  the  hospital,  as  his 
parents  were  instructed  how  to  care  for  him, 
but  he  illustrates  the  altering  of  character 
which  may  occur  in  hysteria  even  in  a  child. 

CASE  V.  Irish- American.  Female.  Age 
11.  School-girl. 

This  child-patient  was  depressed  and  seemed 
to  feel  it  a  reproach  that  she  could  not  use 
her  right  hand.  She  had  an  unhappy  life  in 
an  orphan  asylum.  Cheerful  surroundings, 
and  constant  encouragement  to  use  her  hand 
in  exercise,  and  manual  work,  and  her  success 
in  basketry,  helped  her  much.  She  went 
home  cured. 


VI 

EPILEPSY 

OCCUPATION  work  for  epileptics  must  be 
planned  so  as  to  avoid  fatigue  from  over- 
exertion  which  might  bring  on  an  attack,  and 
so  as  to  avert  any  danger  of  injury  from  fall- 
ing on  sharp  tools  or  getting  caught  in  ma- 
chinery during  a  seizure.  This  might  seem  to 
limit  the  work,  but  much  remains  which  can  be 
attempted  without  risk  and  there  is  no  class 
of  patients  more  benefited  by  occupation 
than  epileptics.  There  is  nothing  in  their  ill- 
ness to  prevent  enjoyment  in  work,  and  the 
satisfaction  in  accomplishment  which  comes 
from  technical  skill.  Without  great  original- 
ity, as  a  rule,  they  nearly  always  show  per- 
sistency and  the  desire  to  excel,  so  that  their 
work  is  generally  substantial. 

The  actual  teaching  of  epileptics  is  marked 
by  great  differences  among  the  various  pa- 
tients. Out  of  fifty  or  more  taught,  a  few  ap- 

128 


EPILEPSY  129 

peared  dull  mentally;  others  were  lethargic 
and  lacking  in  interest  because  they  were  so 
disheartened  at  finding  themselves  the  victims 
of  a  disease  which  they  believed  would  cut 
them  off  from  all  social  activity  and  success 
in  life;  others  spent  their  time  in  looking  for- 
ward with  dread  to  attacks;  others  were  per- 
fectly cheerful,  with  a  normal  attitude  to- 
ward life.  It  was  difficult,  on  account  of  the 
self-evident  nature  of  their  malady  to  avoid 
some  talk  about  it.  It  was,  therefore,  pos- 
sible for  the  teacher  to  reassure  the  disheart- 
ened often  with  reports  of  successful  work 
done  by  individuals  and  in  epileptic  colonies 
and  to  try  to  convince  them  that  the  quality  of 
their  work  and  their  attitude  toward  life  were 
under  their  own  control  and  need  not  be  af- 
fected by  their  illness.  Turning  the  atten- 
tion toward  readjustment  often  seemed  to 
produce  a  change  in  the  patient  and  a  salutary 
effect  in  causing  him  to  plan  for  the  future  in- 
stead of  brooding  over  his  misfortunes.  Chil- 
dren were  naturally  less  affected  in  spirit 
than  adults  by  the  disease,  as  they  seldom 
knew  what  it  was  that  caused  their  uncon- 
sciousness, but  they  were  often  subject  to 


130  THE  WORK  OF  OUR  HANDS 

spells  of  dullness  or  irritability  before  an  at- 
tack, which  prevented  work.  It  seemed  bet- 
ter when  such  a  condition  manifested  itself, 
to  let  the  child  rest,  as  work  had  no  effect  in 
changing  the  course  of  events. 

One  characteristic  stood  out  markedly  in 
most  of  the  patients  taught,  a  peculiar  degree 
of  absorption  in  what  they  were  doing,  so  that 
once  started  they  did  not  easily  turn  their  at- 
tention to  anything  else.  This  persistency 
was  marked  even  in  young  children,  amount- 
ing almost  to  stubbornness. 

Many  of  these  children  showed  poor  mem- 
ory for  mental  work,  but  excellent  memory  for 
handwork.  What  was  demonstrated  by  the 
teacher's  own  hands  generally  remained  fresh 
in  the  child's  mind  and  he  usually  found  great 
satisfaction  in  applying  this  knowledge.  In 
some  cases  the  special  senses  seemed  to  give 
feeble  sensations  and  ignorance,  appearing  al- 
most like  feeble-mindedness,  was  not  uncom- 
mon, even  where  the  will-power  seemed  to  be 
good.  Other  children  were  really  feeble- 
minded. 

Manual  work  is  an  important  part  of  the 
training  of  the  epileptic  child,  not  only  on  ac- 


EPILEPSY  131 

count  of  the  opening  up  of  the  avenues  of  the 
special  senses,  thus  allowing  freer  expression 
of  activity,  but  for  social  reasons  as  well. 
The  possibility  of  his  life  being  somewhat  iso- 
lated, if  he  lives  at  home,  and  the  trend  to- 
ward the  choice  of  some  simple  manual  work 
as  a  means  of  livelihood  in  later  years,  must 
be  considered.  It  would  doubtless  be  impos- 
sible for  the  State  to  provide  a  home  and 
training  for  every  epileptic,  no  matter  how 
desirable  segregation  might  be.  Aside  from 
this,  there  are  city  dwellers  who  would  like, 
if  possible,  to  keep  their  epileptic  children  with 
them,  and  would  gladly  try  to  follow  direc- 
tions as  to  diet,  regular  hours,  etc.  Educa- 
tion, however,  is  a  question  which  must  gen- 
erally be  settled  outside  the  home,  for  some 
children  well  cared  for  physically  grow  up  in 
deplorable  ignorance,  their  parents  being  un- 
fit to  teach  them.  They  are  often  unable  to 
fit  into  the  ungraded  classes  of  the  public 
schools,  as  there  is  no  one  to  take  them  to  and 
from  school.  Idleness  certainly  breeds  de- 
generacy in  such  cases.  Many  parents  of 
epileptic  children  taught  by  the  writer  have 
complained  of  their  children's  impudence, 


132  THE  WORK  OF  OUR  HANDS 

sulkiness,  bad  temper,  etc.,  yet  these  very 
boys  and  girls  worked  happily  for  several 
hours  a  day  in  the  hospital  workshop,  never 
showing  these  defects,  except  just  before  or 
after  an  attack.  One  little  girl  of  nine  had 
such  a  report  from  her  mother;  she  was  ex- 
tremely ignorant  and  it  was  evident  that  no 
effort  had  been  made  to  teach  her.  She  was 
anxious  to  learn  and  although  backward,  with 
no  more  knowledge  than  she  should  have  had 
at  five  years,  she  at  once  began  to  catch  up 
mentally.  Her  mother  was  given  careful  di- 
rections as  to  how  to  teach  her,  and  her  visit 
to  the  hospital,  while  it  ended  in  the  confirma- 
tion of  the  mother's  fears  in  regard  to  the 
nature  of  the  child's  illness,  brought  much  help 
to  both. 

Among  those  simple  industries  suitable  to 
be  taught  to  epileptic  children,  reed  basketry, 
chair  caning  and  coarse  knitting  on  wooden 
needles  are  safe;  sewing  and  raffia  basketry 
are  proscribed  for  those  liable  to  frequent  at- 
tacks. Running  the  printing  press  or  any 
other  machine  is  not  safe,  but  weaving  is  en- 
tirely satisfactory.  It  may  be  recalled  that 
Silas  Marner  earned  his  living  as  a  weaver, 


EPILEPSY  133 

in  spite  of  his  strange  attacks  of  unconscious- 
ness. This  refers,  of  course,  to  the  old  fash- 
ioned weaving  by  hand  and  foot  power.  Ma- 
chine weaving  on  a  power  loom  would  be 
proscribed. 

All  these  industries  are  mentioned  as  educa- 
tional occupation  work.  Gainful  work  might 
in  some  cases  grow  out  of  them,  and  there 
are  many  other  forms  of  work  equally  suit- 
able. Farming  is  perhaps  the  most  satisfac- 
tory, as  it  is  healthful,  interesting  and  re- 
munerative and  can  be  carried  on  even  if  a 
mental  degeneration  sets  in  as  it  sometimes 
does.  Colonies  like  the  Craig  Colony  have 
demonstrated  the  suitability  of  agricultural 
work  both  in  keeping  the  patients  in  good 
general  health  and  in  keeping  them  happy 
and  efficient. 

Chorea 

Children  with  beginning  chorea  are  usually 
so  ill  as  to  be  unable  to  do  any  work  for  a  few 
weeks,  and  are  frequently  ordered  rest  in  bed 
and  isolation.  Later,  when  the  choreic 
twitchings  begin  to  be  less  marked,  these  pa- 
tients can  begin  work,  but  it  must  be  very 


134  THE  WORK  OF  OUR  HANDS 

light,  at  first,  and  planned  so  as  to  give  the 
maximum  amount  of  simple  pleasure  with  the 
minimum  amount  of  fatigue.  Work  seems  to 
help  the  patient  by  putting  him  temporarily  in 
a  condition  of  normal  interest  in  something 
outside  of  his  own  illness,  although,  as  a  rule, 
these  children  seem  indifferent  to  work  and  to 
what  is  going  on  around  them.  They  seldom 
attempt  to  express  their  feelings  in  words,  and 
are  credited  with  being  dull  and  sulky.  A 
close  observer  realizes  how  really  ill  they  are. 
Most  children,  after  a  while,  meet  the  teacher 
half  way  when  occupation  is  suggested.  They 
require  tact  and  patience  in  handling,  how- 
ever, and  the  teacher  must  try  to  regard  the 
dullness  as  a  phase  of  the  disease,  not  as  a  trait 
of  character.  As  such  children  often  remain 
lacking  in  spontaneity  for  some  time,  it  is  bet- 
ter to  set  them  to  work  as  soon  as  the  spas- 
modic movements  have  subsided  sufficiently, 
unless,  as  is  sometimes  the  case,  an  attempt  at 
voluntary  movement  causes  the  twitching  to 
increase  greatly. 

Each  choreic  child  or  youth  is  a  separate 
problem;  out  of  more  than  fifty  taught,  each 
one  showed  individual  traits,  but  there  were  a 


CHOREA  135 

few  marked  groups.  Some  patients  were  able 
to  get  a  fair  voluntary  control  of  the  hands 
while  still  quite  ill,  and  to  force  themselves  to 
write,  and  also  to  do  good  manual  work. 
Others  whose  general  condition  was  good  still 
had  uncontrollable  muscular  movements  which 
prevented  accurate  work.  Others  seemed 
nervously  exhausted  and  could  hardly  work  at 
all,  mental  and  physical  energies  alike  being 
at  a  very  low  ebb.  Generally  speaking,  they 
were  not  good  workers,  and  only  in  excep- 
tional cases  were  they  able  to  do  well  techni- 
cally, but  just  as  neurasthenics  have  to  be 
trained  to  work  by  slow  degrees,  these  chil- 
dren had  to  be  taught  step-by-step.  The  pur- 
poseless movements  discouraged  them  and  it 
took  a  distinct  effort  to  rouse  the  attention  suf- 
ficiently to  get  any  attempt  at  working;  this 
effort  had  to  be  repeated  every  day,  as  the 
interest  did  not  seem  to  carry  from  one  day 
to  another;  it  seemed  as  if  the  child  sunk  again 
into  self-absorption  between  lessons  and  for- 
got his  work.  However,  these  children  may 
have  learned  much  more  than  was  apparent, 
and  may  have  stored  up  knowledge  which 
would  help  them  later.  On  visits  to  the  phy- 


136  THE  WORK  OF  OUR  HANDS 

sicians  in  the  dispensary  after  they  were  bet- 
ter, some  of  these  patients  asked  to  see  the 
teacher,  and  told  her  of  braided  raffia  work, 
etc.,  which  they  had  done  at  home,  by  remem- 
bering work  done  at  the  hospital.  One  little 
girl  of  eleven,  who  was  too  ill  to  be  ordered 
regular  work,  happened  to  have  a  chance  one 
day  to  sort  over  some  large  bright-colored 
beads,  suitable  work  for  a  child  of  five  or  six. 
Her  hands  twitched,  and  she  looked  ill  and 
unhappy,  and  the  teacher  was  surprised  on  the 
child's  return  about  six  months  later  to  have 
the  little  girl  tell  her  how  much  she  had  en- 
joyed sorting  those  beads.  At  the  time  of  this 
visit,  which  was  in  order  to  allow  the  physician 
to  judge  of  the  child's  progress,  she  was  able 
to  do  simple  basketry,  but  still  seemed  behind 
other  children  of  her  age,  not  only  in  manual 
work,  but  in  mentality. 

The  question  of  what  is  suitable  occupation 
work  for  a  child  with  chorea  requires  consid- 
eration. It  must  be  simpler  than  would  ordi- 
narily be  given  a  normal  child  of  the  same  age, 
as  is  true  in  all  occupations  for  children  whose 
physical  disability  enters  into  the  possibilities 
of  success.  Mental  dullness  and  lack  of  mem- 


CHOREA  137 

ory  are  also  factors  to  be  reckoned  with.  In 
most  patients  work  suitable  to  the  child's  age 
did  not  rouse  any  keener  interest  than  that 
much  simpler.  But  the  work  chosen  should 
be  worth  doing,  no  matter  if  it  is  simple 
enough  to  be  suited  to  a  kindergarten  child. 
Work  with  color  seemed  to  arouse  the  atten- 
tion, and  painting  (as  the  use  of  a  brush  is 
easier  than  holding  a  pencil  or  scissors) 
seemed  very  good  for  the  first  step.  Free- 
hand drawing  of  outlines  was  generally  impos- 
sible, and  the  use  of  well-designed  cards, 
printed  in  outline  to  be  filled  in,  proved  a  sat- 
isfactory way  to  get  around  this  difficulty,  and 
to  give  specially  good  training  in  muscular 
control.  These  cards  come  printed  on  rough 
paper,  in  designs  of  flowers,  fruits,  and  of 
Easter  and  Christmas  subjects.  Some  origi- 
nality is  allowed  in  the  choice  of  color  in  fill- 
ing in. 

CASE  I. 

A  girl  of  11,  who  could  not  even  braid  raf- 
fia, constantly  compared  her  present  unsuc- 
cessful work  with  what  she  had  been  able  to 
do  and  was  discouraged  by  her  lack  of  success, 
found  that  she  could  do  effective  work  with 


138  THE  WORK  OF  OUR  HANDS 

these  cards,  and  at  once  began  to  gain  self- 
confidence.  Later  she  cut  out  pictures  and 
made  a  scrap-book,  and  eventually  was  able 
to  do  raffia  work.  The  scrap-books  she  made 
gave  pleasure  to  many  other  children  who 
were  unable  to  work  at  all,  but  were  well 
enough  to  be  interested. 

CASE  II. 

A  boy  of  11  recovered  the  use  of  his  hands 
slowly  and  was  forbidden  to  work,  but  he  knew 
all  that  was  going  on  in  the  workshop,  and 
watching  others  seemed  to  rouse  him  out  of 
his  own  bad  feelings.  Every  day  he  asked  his 
physician  to  be  allowed  to  work,  but  when  at 
last  he  got  consent,  he  found  to  his  discourage- 
ment that  he  still  made  involuntary  move- 
ments. At  first  he  could  work  only  at  some- 
thing that  could  be  fastened  in  position,  and 
did  fret-sawing,  in  which  the  work  was  held 
securely,  and  the  tool  alone  required  manipu- 
lation. He  sawed  out  many  little  animals  for 
smaller  children  who  were  also  patients.  This 
boy  was  at  first  dull  and  easily  discouraged; 
after  each  failure  he  would  go  off  by  himself 
and  sulk,  but  the  teacher  took  pains  to  show 
him  exactly  how  to  use  his  hands,  and  he 


CHOREA  139 

gradually  became  quite  expert  in  fret-sawing. 
Later  he  took  up  chair-caning,  which  he  did 
fairly  well.  Training  in  the  use  of  the  hands 
bore  unexpectedly  good  fruit  in  this  case,  and 
the  careful  teaching  exactly  how  to  handle 
materials  and  tools,  and  insisting  on  the  child 
imitating  the  teacher's  movements,  proved  ex- 
cellent discipline.  It  aroused  the  boy's  intel- 
ligence and  he  cooperated  well.  His  sense  of 
touch  and  sight  were  both  dull.  This,  with 
the  corresponding  lack  of  motor  control, 
formed  such  a  double  burden  that  no  wonder 
the  boy  seemed  dull  under  such  physical  limi- 
tations. His  mental  ability,  however,  seemed 
to  be  good,  and  at  last  reports  he  had  nearly 
caught  up  with  others  of  his  age.  The  teacher 
learned  much  from  her  observation  of  this 
case,  and  afterwards  tried  to  simplify  the  work 
given  to  choreic  children,  and  confine  it  to 
work  which  makes  a  vigorous  appeal  to  the 
color  sense  and  to  touch,  and  the  muscular 
sense,  keeping  also  to  work  so  easy  as  to  be 
done  successfully,  minimizing  the  limitations 
of  illness,  instead  of  emphasizing  them. 

One  other  type  of  choreic  patient  worthy  of 
special  attention  is  the  over-ambitious  child 


140  THE  WORK  OF  OUR  HANDS 

said  to  be  broken  down  by  overwork.  Such 
children  are  not  dulled  by  the  disease  to  any 
great  extent,  and  their  interests  remain  nor- 
mal. After  the  spasmodic  twitchings  mod- 
erate they  can  work  for  short  lessons  at  ordi- 
nary manual  work.  If  kept  at  too  childish 
work  they  become  depressed  and  lose  their 
self-confidence  and  it  is  well  to  plan  work  in- 
teresting enough  to  keep  up  their  spontaneous 
attention. 

A  little  girl  of  nine,  who  was  very  small  for 
her  age,  had  been  attending  music  classes  and 
sewing  school,  besides  public  school  and  was 
quite  expert  in  embroidery.  On  coming  to  the 
hospital  her  physician  ordered  her  to  rest  in 
the  open  air,  but  her  interest  in  the  work  adult 
patients  were  doing  induced  her  to  beg  her 
doctor  to  allow  her  to  work  at  the  same  thing, 
chiefly  heavy  reed  basketry.  A  compromise 
wras  made  by  which  she  was  to  work  a  certain 
length  of  time  on  condition  she  rested  the  re- 
maining time.  She  kept  her  end  of  the  bar- 
gain conscientiously,  and  while  she  used  much 
lighter  materials  than  her  adult  fellow-work- 
ers, she  made  the  same  kind  of  baskets.  She 
was  slow  in  working  and  probably  below  her 


CHOREA  141 

normal  level  at  quickness  of  thought  and  in 
the  control  of  her  hands.  This  child  had 
never  wanted  to  play;  her  great  aims  in  life 
were  learning  and  doing.  The  necessity  of  a 
time  for  rest  and  play  was  explained  to  her, 
as  it  seemed  she  was  more  to  be  depended  on 
than  her  mother  for  her  future  program, 
and  she  promised  to  carry  out  any  suggestions 
that  would  help  her  to  catch  up  in  size  with 
others  of  her  age  and  make  her  grow  into  a 
strong  woman.  Many  others  of  these  chil- 
dren seemed  sensible  and  willing  to  learn,  in 
spite  of  their  seeming  dullness  and  retarda- 
tion. Most  of  them  had  always  been  rather 
delicate  and  seemed  liable  to  remain  fragile. 
It  seems,  therefore,  that  the  habit  of  system- 
atic industry,  and  the  satisfaction  in  doing 
skillful  hand  work  are  particularly  worth  cul- 
tivating in  them,  as  aids  in  giving  stability  to 
an  organization  liable  to  remain  nervously  un- 
stable. 


VII 

MENTAL  DISEASES 

WORK  may  be  made  the  connecting  link  for 
the  mentally  afflicted,  between  the  normal 
world  of  working  men  and  women  and  that 
other  world  in  which  the  inmates  are  isolated 
by  abnormality  in  ideas  and  acts.  The  in- 
stinct of  workmanship  frequently  remains 
after  reason  is  permanently  overthrown. 
Many  times  those  whose  idle  hours  are  most 
wretched  on  account  of  distressing  delusions 
become  self -forgetful  when  at  work,  and  reach 
a  physical  and  mental  altitude  far  higher  than 
would  be  expected.  Nearly  all  classes  of  in- 
sane people  can  work,  except  those  in  the  ad- 
vanced stage  of  general  paresis,  and  those  in 
certain  temporary  states  of  extreme  depres- 
sion or  exaltation. 

Manic  Depressive  Insanity 

There  has  been  considerable  difference  of 
opinion  as  to  whether  patients  in  an  excited 

142 


MENTAL  DISEASES  143 

state  should  be  urged  to  work.  No  absolute 
rule  can  be  laid  down,  but  the  general  opinion 
among  modern  alienists  is  in  favor  of  work  as 
a  remedy  even  in  considerably  excited  cases. 
Hydrotherapy  is  of  unquestioned  value,  but 
work  should  follow  the  calming  measures  as 
soon  as  possible.  The  patient  who  puts  his 
excess  nervous  energy  into  work  is  far  less 
likely  to  need  restraint  or  sedatives. 

In  teaching  manic  patients  in  a  state  of  ex- 
altation a  careful  distinction  should  be  drawn 
between  occupation  which  is  intended  to  hold 
the  attention  and  real  creative  work.  An  ex- 
cited patient  restlessly  moving  about,  and 
unable  to  "think  straight,"  could  hardly  be  ex- 
pected to  concentrate  the  attention  and  sit  still 
an  hour  or  so  planning  out  and  executing 
basket  designs.  But  the  aimless  psycho- 
motor  activity  which  prompts  the  tearing  up 
of  paper  into  bits  might  be  directed  to  tearing 
strips  of  cloth  for  weaving,  or  bits  of  paper  to 
fill  a  pillow  cover.  Winding  yarn,  or  winding 
carpet  rags  on  a  reel,  or,  in  fact,  any  simple 
work  which  allows  free  play  of  some  part  of 
the  body  frequently  holds  the  attention,  espe- 
cially if  the  work  is  with  bright-colored  ma- 


144  THE  WORK  OF  OUR  HANDS 

terials.  Work  that  can  be  done  standing 
seems  often  satisfactory  to  the  patient,  and  if 
he  wishes  to  walk  about  occasionally,  it  is  often 
a  relief  to  do  so.  The  teacher  must  keep  in 
mind  that  the  restlessness  which  is  a  charac- 
teristic of  the  state  must  find  some  vent. 
Frequently  the  patient  in  such  a  state  is  ob- 
serving keenly  everything  that  is  going  on, 
and  is  afterward  able  to  make  use  of  knowl- 
edge gained  from  watching  others.  An  inci- 
dent to  illustrate  this  is  the  case  of  a  young 
girl  who  was  too  excited  to  leave  her  room 
and  was,  in  fact,  under  the  constant  care  of  a 
nurse,  who  happened  to  be  making  a  basket. 
The  patient,  talking  much  of  the  time  to  imag- 
inary companions,  was  apparently  oblivious  to 
the  nurse.  But  afterward,  when  she  became 
able  to  work,  she  displayed  a  surprising 
knowledge  of  basketry.  This  same  patient 
was  sent  to  a  country  home  where  she  had  an 
opportunity  to  weave.  She  seemed  to  like  the 
freedom  of  motion,  and  the  bright  colors  em- 
ployed, but  her  attention  was  diverted  by  the 
conversation  of  imaginary  companions,  to 
whom  she  must  address  remarks,  friendly  or 
unfriendly,  in  an  excited  manner.  It  was 


MENTAL  DISEASES  145 

useless  to  try  to  convince  her  that  there  was 
no  one  present  but  herself  and  the  teacher,  and 
the  latter  tried  the  expedient  of  getting  her 
attention  back  on  her  work  by  holding  up  the 
shuttle,  or  a  bit  of  bright  material  for  weaving. 
She  soon  became  able  to  talk  to  the  teacher 
intelligently  about  her  work  and  planned  and 
made  two  rugs.  It  seemed  that  the  novelty 
of  doing  something  unfamiliar  was  a  whole- 
some stimulus  in  this  particular  case.  She 
was  large  and  naturally  muscular,  and  took 
pleasure  in  the  use  of  her  strength.  Weaving 
seemed  to  be  just  the  thing  for  her. 

Another  type  of  manic  excitement  is  repre- 
sented by  a  Jewish  woman  of  about  fifty.  She 
would  sit  humped  up  for  a  few  minutes  and 
then  get  up  and  walk  around  excitedly.  She 
did  this  at  least  a  dozen  times  during  a  short 
interview.  When  the  teacher  asked  her  if  she 
would  like  to  complete  a  basket  begun  by  an- 
other patient  who  was  just  leaving,  she  ex- 
pressed pleasure,  went  to  work  at  once,  and 
did  not  get  up  again  for  over  an  hour,  al- 
though she  had  to  be  occasionally  encouraged. 
Her  expression,  at  first  quite  wild,  became 
softened  to  one  of  intentness  in  her  work,  and 


146  THE  WORK  OF  OUR  HANDS 

she  smiled  at  the  teacher  and  thanked  her  for 
giving  her  something  to  do,  as  she  said  she 
liked  to  work,  and  had  five  children  at  home, 
where  her  hands  were  never  idle.  She  showed 
no  particular  originality,  but  her  work  was 
strong,  and  in  the  course  of  two  or  three  days 
she  had  a  very  satisfactory  basket,  at  least  it 
was  very  satisfactory  to  her.  In  this  woman 
the  liking  for  work  remained  in  the  midst  of 
confusion  in  regard  to  other  things.  There 
are  other  cases  with  whom  work  seems  to  be 
almost  an  impossibility,  unless  the  instructor 
has  the  time  to  give  much  individual  help,  but 
if  the  patient  is  under  the  charge  of  a  nurse 
who  is  interested  in  occupation  work,  and  co- 
operates with  the  teacher,  the  effort  to  arouse 
interest  in  work  is  usually  successful.  The 
adaptability  of  the  nurse  has  much  to  do  with 
the  success  of  the  effort,  because  if  the  nurse 
tries  to  make  the  patient  sit  still  and  work 
steadily  she  generally  fails,  while  if  she  allows 
her  to  get  up  and  walk  around,  and  then  again 
presents  the  work,  perhaps  pointing  out  some 
new  feature,  the  patient  starts  in  again.  For 
the  patient  in  a  highly  excited  state  the  only 
chance  of  success  lies  in  individual  teaching. 


MENTAL  DISEASES  147 

After  the  preliminary  stage  is  past  these  pa- 
tients often  enjoy  group  work;  in  fact,  they 
seem  to  take  particular  pleasure  in  working 
with  others.  They  then  may  take  up  finer 
work. 

In  general,  patients  in  this  state  are  easily 
distractible,  and  even  when  they  are  suffi- 
ciently improved  to  plan  original  work,  they 
need  variety.  Their  physical  uneasiness  usu- 
ally persists  after  their  general  state  is  im- 
proved, and  they  frequently  appear  worse  off 
mentally  than  they  really  are.  This  bad  habit 
of  physical  restlessness  may  frequently  be  cor- 
rected by  occupation  work,  since  it  substitutes 
useful  movements  for  idle  walking,  restless 
moving  of  the  hands,  etc. 

The  choice  of  work  should  be  careful,  and 
what  is  given  the  patients  in  an  extreme  con- 
dition of  excitement  should  be  such  as  to  pave 
the  way  for  more  advanced  work.  Whether 
it  is  familiar  or  not  must  rest  on  the  patient's 
temperament.  Sometimes  familiar  work  ex- 
aggerates the  excitement,  and  something  en- 
tirely new  arouses  wholesome  interest.  In 
other  cases  familiar  work  is  most  satisfying 
unless  it  is  something  connected  with  the  be- 


148  THE  WORK  OF  OUR  HANDS 

ginning  of  the  patient's  malady.  The  work 
must  restore  the  self-confidence  of  the  patient. 
If  it  fails  to  do  this  something  else  must  be 
tried.  It,  therefore,  behooves  the  teacher  to 
invoke  the  physician's  aid  in  finding  out  the 
past  likings  and  abilities  of  the  patient. 

There  is  generally  a  chance  for  the  patient 
to  progress,  and  do  fine  original  work.  The 
foundations  laid  during  the  excited  state  must 
therefore  be  secure.  The  great  danger  is  in 
overstimulating  the  patients,  as  they  are  liable 
to  become  too  eager,  and  to  overestimate  their 
physical  strength.  In  restoring  their  self- 
confidence  care  must  be  taken  not  to  overdo 
it,  and  recreation  must  constantly  be  used  in 
connection  with  the  work. 

Patients  suffering  from  manic  depression 
are  often  at  a  very  low  ebb,  physically  and 
mentally,  and  whatever  work  is  given  should 
be  restful,  planned  to  prevent  the  deteriora- 
tion of  absolute  idleness,  rather  than  the 
stimulation  of  trying  new  work.  It  must, 
however,  be  something  useful,  or  the  patient 
will  be  likely  to  grow  stubborn,  and  refuse  to 
do  anything.  Such  patients  are  frequently 
distrustful  and  working  at  anything  which 


MENTAL  DISEASES  149 

seems  to  them  useless  makes  them  feel  that 
they  are  being  made  fools  of.  They  often 
feel  that  their  friends  were  wrong  in  making 
them  stop  work,  and  to  offer  them  diversional 
occupation  is  adding  insult  to  injury.  In 
dealing  with  such  patients  the  teacher  must 
remember  that  she  is  dealing  with  a  temporary 
condition,  in  individuals  who  will  in  all  proba- 
bility recover,  and  however  simple  the  work 
she  offers  them  it  need  not  be  such  as  could 
legitimately  be  given  to  those  who  are  bound 
to  become  less  and  less  efficient.  Outdoor 
work  is  often  very  helpful  to  such  patients,  if 
it  is  not  too  tiring  physically.  It  is  almost 
impossible  to  keep  the  attention  on  intricate 
work,  and  whatever  tends  to  peace  of  mind  is 
beneficial.  Sometimes  group  work  is  helpful, 
and  sometimes  it  seems  to  make  the  patient 
more  depressed  in  realizing  his  own  ineffi- 
ciency, so  that  it  is  hard  to  make  a  general 
rule,  further  than  that  there  should  be  an  op- 
portunity given  the  patient  to  get  through  a 
trying  period  without  undue  stimulation,  and 
yet  keep  him  occupied  sufficiently  to  prevent 
an  undue  amount  of  leisure  tinie  for  gloomy 
thoughts.  "Keep  constantly  occupied"  is  a 


150  THE  WORK  OF  OUR  HANDS 

direction  frequently  sent  by  the  physician  to 
the  teacher  in  regard  to  such  cases,  but  it  is 
generally  accompanied  by  a  warning  to  avoid 
complex  or  fatiguing  work. 

Mixed  State 

Many  patients  show  both  excitement  and 
depression  at  frequent  intervals.  Most  of 
these  work  better  than  those  suffering  from 
depression.  One  such  case  was  that  of  a 
young  Irishwoman,  whose  chief  symptom  was 
confusion.  She  was  unable  to  distinguish  in- 
dividuals whom  she  saw  every  day,  and  some- 
times was  unable  to  recognize  members  of  her 
own  family.  She  had  days  of  extreme  de- 
pression when  she  refused  to  speak,  or  try  to 
rouse  herself,  but  on  her  better  days  she  got 
satisfaction  from  running  a  small  printing 
press.  She  was  entirely  unable  to  do  even  the 
simplest  basketry  without  constant  supervi- 
sion, as  she  forgot  which  thread  to  weave  with, 
but  she  printed  hundreds  of  cards  without  dif- 
ficulty, and  took  pride  in  her  work.  Later 
her  days  of  depression  became  less  frequent, 
and  she  was  able  to  sew.  Some  months  later 
she  had  another  attack,  and  returned  to  the 


MENTAL  DISEASES  151 

hospital.  She  had  forgotten  the  teacher  and 
attendants,  but  curiously  enough  remembered 
the  printing  press,  and  wanted  to  print. 

Dementia  Prcecox 

Dementia  prsecox  so  often  stops  the  devel- 
opment of  the  mental  faculties  that  work  must 
be  chosen  which  will  not  demand  any  great 
degree  of  originality,  or  future  creative  abil- 
ity. Most  sufferers  from  this  disease,  how- 
ever, are  able  to  do  accurate  work,  and  take 
pleasure  in  it,  and  as  they  are  often  young  at 
the  onset  they  may  be  able  to  gain  mechanical 
skill  which  will  make  good  workmanship  a 
habit.  Good  work  in  itself  prevents  deteri- 
oration, as  it  covers  up  the  marked  failing  in 
efficiency  which  is  characteristic.  Simple  in- 
dustries like  chair  caning,  plain  weaving,  bas- 
ketry, are  suitable  crafts. 

There  are,  however,  difficulties  in  the  way 
of  the  teacher  who  would  get  good  work  from 
this  class  of  patients.  One  is  the  frequent 
occurrence  of  a  catatonic,  or  apathetic  state, 
from  which  the  patient  can  hardly  be  roused 
to  eat,  to  say  nothing  of  working.  This  state 
sometimes  lasts  for  weeks,  and  the  patient 


152  THE  WORK  OF  OUR  HANDS 

may  seem  almost  in  a  stupor,  hardly  conscious 
of  his  surroundings.  It  is  sometimes  a  ques- 
tion whether  it  is  not  as  well  to  let  the  patient 
rest  altogether.  But  a  surprising  amount  of 
construction  work  can  be  accomplished  even  in 
this  state.  It  is  useless  to  try  difficult  work 
in  many  cases,  and  the  teacher's  effort  to  make 
the  patient  think  may  awaken  stubbornness. 
Coarse  knitting  is  so  familiar  that  the  move- 
ments used  require  little  thought;  raffia  work, 
or  anything  else  well  known,  may  do  much  to 
rouse  the  patient's  interest. 

In  the  excited  states  these  patients  like  to 
spend  hours  talking  over  their  grievances,  ex- 
plaining away  their  failures,  and  sometimes 
talking  about  their  strange  beliefs.  It  is  hard 
at  first  to  get  them  to  express  themselves  in 
acts,  as  often  they  seem  to  feel  that  their 
moralizing  and  going  over  and  over  the  same 
ground  in  words  is  valuable,  and  work  would 
be  a  waste  of  time.  The  teacher  has  to  use  a 
good  deal  of  tact  to  get  them  working,  and 
needs  to  have  much  time  for  each  individual. 
There  is  undoubtedly  much  good  material 
going  to  waste  among  this  class  of  patients. 
Self-directed,  they  generally  think  they  can 


MENTAL  DISEASES  153 

accomplish  wonders,  and  really  accomplish 
next  to  nothing.  The  teacher  who  can  direct 
their  activities  into  possible  lines  of  achieve- 
ment is  doing  a  really  great  work.  This  ap- 
plies especially  to  those  who  are  not  obliged 
to  be  placed  permanently  in  institutions.  In 
the  modern  state  hospitals  where  careful  at- 
tention is  given  to  every  type  of  mental  dis- 
ease, many  of  this  class  are  doing  excellent 
work,  but  there  are  many  outside,  who  seem 
more  "queer"  than  actually  insane,  who  fail 
from  year  to  year  in  efficiency,  who  could  be 
helped  by  good  advice  and  good  industrial 
teaching. 

In  the  actual  teaching  of  more  than  a  hun- 
dred cases  of  this  disease  the  writer  found  a 
marked  indifference  to  the  work  of  others  to 
be  characteristic;  they  never  compared  their 
work  with  that  of  others,  or  even  with  the  sam- 
ples in  the  workroom,  unless  asked  to  do  so. 
Their  work  improved  steadily,  and  usually 
showed  good  color  and  design,  and  a  sense  of 
proportion,  but  was  without  originality.  It 
afforded  satisfaction  to  the  workers,  who  spent 
many  hours  a  day  pleasantly  occupied.  Most 
of  these  patients  seemed  to  the  teacher  capable 


154,  THE  WORK  OF  OUR  HANDS 

of  real  success  in  simple  handicraft  work,  not 
only  on  account  of  their  willingness,  after  they 
were  fairly  started,  but  because  they  were  able 
to  do  solid,  strong  work. 

Many  interesting  patients  were  among  this 
group.  One  man,  who  had  been  a  typesetter 
in  his  youth,  had  dropped  down  to  be  a  day 
laborer.  His  hands  were  hardened  with 
coarse  work,  and  it  took  him  some  time  to 
learn  again  to  handle  type.  He  did  not  be- 
come very  expert,  but  he  reassured  himself 
that  he  had  not  lost  all  his  manual  skill,  and 
this  appeared  to  give  him  much  satisfaction. 
It  seemed  that  he  had  ability  to  be  more  than 
a  laborer,  but  not  the  ability  to  get  into  a  bet- 
ter paid  and  higher  grade  of  work,  unless 
helped  by  some  one,  and  this  help  he  had  evi- 
dently lacked. 

One  girl  who  had  been  a  milliner  came  to 
the  Neurological  Institute  very  ill  physically 
and  mentally.  For  nearly  two  months  she 
worked  in  the  occupation  room  without  volun- 
teering a  single  remark,  and  seldom  answering 
if  addressed.  Yet  during  that  time  she  did 
much  neat  work,  making  towels,  winding 
bandages,  sewing  raffia  napkin-rings  and 


MENTAL  DISEASES  155 

baskets.  In  all  this  work  she  seemed  to  show 
no  interest,  but  at  last  she  noticed  a  doll's  hat 
that  some  one  else  was  making.  She  made 
and  trimmed  one  herself  and  began  to  appear 
slightly  less  inert.  Materials  were  given  her 
to  make  herself  a  spring  hat,  which  she  did 
very  neatly,  copying  the  trimming  from  a 
fashion  book.  Soon  after  this  she  went  home. 
After  she  had  been  away  three  or  four 
months  she  returned.  She  disclaimed  all  rec- 
ollection of  making  herself  a  hat,  but  at  once 
took  up  millinery  where  she  had  left  off,  trim- 
ming a  doll's  hat  as  soon  as  the  materials  were 
set  before  her. 

Most  of  these  patients  who  were  able  to  work 
successfully  expressed  no  mental  disturbance 
in  words  or  actions  while  engaged  in  their 
work,  but  at  times  nearly  all  of  them  appeared 
to  be  in  a  reverie  and  it  was  hard  to  get  them 
started  working. 


VIII 

BORDER-LINE  CASES 

MENTAL  idiosyncrasies  such  as  incessant 
worry,  depression,  fear,  etc.,  often  become  so 
marked  as  to  render  their  victims  unfit  for 
business  or  family  life.  As  far  as  the  teach- 
er's attitude  is  concerned,  it  makes  little  dif- 
ference whether  these  are  delusions  or  only 
foolish  worries.  They  alike  arrive  at  the  re- 
sult of  causing  their  unfortunate  possessors  to 
appear  "queer"  and  to  expose  them  frequently 
to  endless  and  useless  argument  from  their 
friends  and  relatives,  who  think  they  can  talk 
them  out  of  their  "strange  notions."  Fre- 
quently they  are  put  under  the  care  of  the 
neurologist,  to  give  him  the  opportunity  to 
observe  and  to  ascertain  whether  the  symp- 
toms are  based  on  "nervousness"  or  indicate 
incipient  insanity.  Formerly  such  afflicted 
individuals  frequently  were  committed  to  in- 
sane asylums,  and  we  have  great  reason  to  be 

156 


BORDER-LINE  CASES  157 

thankful  that  with  more  extended  knowledge 
and  more  humane  methods,  recoveries  can 
often  be  made  without  this  final  step.  These 
so-called  border-line  cases  are  particularly  in- 
teresting to  occupation  teachers,  as  they  are 
often  benefited  surprisingly  by  work.  While 
they  might  be  unable  to  pursue  their  regular 
callings  they  are  usually  able  to  do  ordinary 
craft  work,  with  an  immediate  result  in  restor- 
ing their  self-confidence  and  drawing  their 
attention  from  their  distressing  thoughts. 

In  many  cases,  the  attitude  toward  work  re- 
mains normal  and  the  natural  liking  for  activ- 
ity thus  finding  vent,  gives  a  marked  renewal 
of  energy.  Sometimes  interest  in  work  pre- 
cedes ability,  and  the  process  of  getting 
started  at  really  valuable  work  is  a  slow  one, 
but  there  are  very  few  who  cannot  eventually 
do  good  work. 

Women  accustomed  to  needlework  fre- 
quently find  the  same  relief  in  doing  some- 
thing familiar,  but  generally  are  unable  to 
plan  new  work  without  help.  On  the  other 
hand,  some  dressmakers  find  anything  con- 
nected with  their  avocation  disturbing,  and 
need  something  entirely  novel. 
V 


158  THE  WORK  OF  OUR  HANDS 

Many  of  these  patients  seem  to  benefit 
much  more  by  work  requiring  considerable 
physical  energy  than  by  sedentary  occupation ; 
others  find  pleasure  in  doing  intricate  work 
demanding  close  attention,  such  as  the  making 
of  raffia  hats,  bags  and  lamp  shades,  made  in 
Solomon's  knots.  It  is  not  always  necessary 
to  begin  with  simple  work;  quite  often  some- 
thing intricate  seems  to  be  beneficial  in  rousing 
the  patient  to  show  his  ability. 

Where  a  patient  shows  a  liking  for  any  par- 
ticular thing,  this  work  will  generally  prove  to 
be  of  benefit,  and  in  general  it  may  be  said 
that  if  the  work  gives  pleasure,  and  is  in  accord 
with  the  ideas  and  capabilities,  so  that  it  stimu- 
lates effort,  it  is  well  chosen. 

The  ability  to  work  in  groups  is  frequently 
lost  in  these  patients,  and  it  is  well  for  the 
teacher  to  try  to  get  them  gradually  accus- 
tomed to  working  with  others,  so  as  to 
avoid  the  danger  of  absorption  in  depressing 
thoughts.  Also,  most  working  people,  even 
housewives,  have  to  work  with  others  about 
them,  and  it  is  well  for  the  patients  on  recov- 
ery to  have  the  habit  of  being  with  other  peo- 
ple at  work.  It  is  not  necessary  to  consider 


BORDER-LINE  CASES  159 

reeducation  in  new  means  of  livelihood,  as 
many  such  cases  are  able  to  resume  their  ordi- 
nary work;  occupation  work  while  they  are  ill 
is  a  curative  measure.  These  remarks,  how- 
ever, apply  only  to  those  who  are  regaining 
their  normal  condition;  those  whose  malady  is 
progressive  must  be  taught  according  to  the 
nature  of  their  disability. 


IX 

WOBK   WITH   THE  AGED 

THE  "Good  old  age  released  from  care"  of 
which  the  poet  sings  may  be  so  care-free  as  to 
be  exceedingly  dull  and  monotonous.  No  one 
likes  to  be  considered  past  his  usefulness,  and, 
as  a  matter  of  fact,  most  old  people  are  "laid 
on  the  shelf"  in  America  long  before  their 
working  days  should  be  over.  For  him  who 
loves  to  read,  a  period  for  adding  to  knowl- 
edge which  can  be  interpreted  through  the  ex- 
perience of  a  long  life,  may  be  a  most  happy 
time,  but  for  the  more  common  type,  getting 
pleasure  from  activity  rather  than  from  con- 
templation, old  age  offers  few  resources.  The 
initiative  for  seeking  new  fields  is  a  thing  of 
the  past,  and  help  must  come  from  without. 

What  can  be  a  more  pathetic  spectacle  than 
that  of  rows  and  rows  of  aimless  old  men  and 
women,  sitting  in  the  wards  of  an  almshouse, 
dull  and  apathetic,  with  no  thought  beyond  the 

160 


WORK  WITH  THE  AGED  161 

next  meal?  Truly  enough  Cicero  said  that 
"To  one  oppressed  with  poverty,  however 
otherwise  qualified,  old  age  can  never  prove 
easy."  It  makes  very  little  difference  how  far 
poverty  in  old  age  may  be  due  to  self-indul- 
gence, to  lack  of  forethought,  or  to  inability  to 
control  circumstances,  the  fact  remains  that 
all  these  faults  may  have  come  from  a  lack  of 
physical  and  mental  equipment  at  the  outset, 
or  from  lack  of  proper  training.  Judgment 
should  not  be  passed  too  hastily.  We  are 
prone  to  assume  that  a  poverty-stricken  old 
age,  as  a  ward  of  the  State,  must  be  a  just 
desert.  A  careful  study  of  the  groups  in  any 
almshouse  affords  a  surprising  number  not 
much  past  middle  life,  weak,  inefficient  faces, 
of  those  who  have  never  been  able  to  make 
good  in  our  complex  social  system. 

This  is  not  the  place  to  go  into  the  study  of 
heredity,  to  trace  out  the  decadence  of  a  fam- 
ily from  generation  to  generation  till  pauper- 
ism is  the  last  step  reached,  nor  is  it  fitting  here 
to  take  up  the  question  of  the  ravages  of  alco- 
hol. The  immediate  problem  to  be  considered 
is  what  can  be  done  with  the  thousands  now 
"prisoners,"  actually  if  not  nominally,  in  the 


162  THE  WORK  OF  OUR  HANDS 

"city  homes"  and  in  poor-houses  all  over  this 
country.  The  beginning  already  made  has 
been  surprisingly  successful.  In  nearly  every 
institution  where  work  has  been  introduced 
vitality  has  seemed  to  rise  higher,  not  only  in 
those  able  to  work,  but  also  in  those  able  only 
to  watch.  Life  has  more  interest,  and  there 
is  something  to  which  to  look  forward.  Craft 
work  is  a  pleasant  change  from  the  routine  of 
housework,  and  "doing  chores."  The  work 
itself  may  be  planned  so  as  to  be  of  no  mean 
economic  value.  For  instance,  braided  rag 
rugs,  made  from  their  discarded  clothing,  pro- 
vides nearly  seventy  men  with  work  in  the 
Brooklyn  "City  Home."  These  rugs  are 
good  in  color,  and  well  made,  and  of  immedi- 
ate use  all  over  the  building.  Baskets  for 
various  uses  in  the  home  are  also  made. 
Where  money  is  not  given  to  the  workers,  it 
may  be  hard  to  keep  up  the  enthusiasm,  but  if 
the  work  is  so  eminently  practical  as  in  this 
case,  the  desire  to  see  the  work  used  adds  to 
the  interest. 

Both  women  and  men  like  basketry.     Knit- 
ting,  crocheting,   and  sewing  are   of   course 


IN   THE   WARDS   OF    THE    LINCOLN    HOSPITAL   AND 
HOME,  NEW  YORK  CITY. 

Quite  often  it  is  possible  to  carry  on  light  work  in  the  hospital 
wards  and  without  heavy  equipment. 


WORK  WITH  THE  AGED  163 

especially  the  province  of  the  former.  Net- 
ting hammocks  is  another  ancient  industry 
which  men  enjoy,  and  there  is  almost  always 
some  old  sailor  who  knows  how  to  put  in  the 
rings  and  side  cords  in  a  truly  "ship-shape" 
way,  which  will  interest  every  one.  Some- 
times the  products  of  one  place  can  be  traded 
for  those  of  another;  for  example,  hammocks 
might  be  exchanged  for  rope  door  mats,  or  for 
braided  rugs.  The  industries  mentioned  may 
be  considered  typical.  Weaving  is  also  suit- 
able, but  provides  occupation  for  only  one  or 
two  at  a  time.  Chair  caning  is  always  useful. 

Undoubtedly  the  earning  of  money  is  a 
stimulus  to  the  interest,  but  as  in  some  cases 
the  will-power  is  so  destroyed  by  the  indul- 
gence in  alcohol  or  drugs,  that  it  is  dangerous 
to  allow  the  worker  money;  a  rule  is  often 
made  that  the  payment  must  be  made  in  some 
other  way,  extra  tobacco,  food  or  clothing,  or 
a  treat  of  some  kind.  This  may  be  used  as  a 
step  toward  payment  in  money. 

A  most  wholesome  stimulus  is  well-earned 
praise.  Variety  is  necessary  to  keep  up  the 
interest.  Little  opportunity  should  be  al- 


164  THE  WORK  OF  OUR  HANDS 

lowed  for  depressing  introspection  or  retro- 
spection, and  if  the  work  is  changed  in  form 
if  not  in  kind  the  attention  is  held. 

Work  should  be  given  tactfully  so  as  to 
keep  the  worker  from  feeling  his  helplessness. 
No  one  likes  to  be  reminded  that  he  is  growing 
decrepit,  and  it  is  just  as  easy  for  the  teacher 
to  leave  the  pupil  at  the  end  of  a  lesson  with 
a  sense  of  well  being,  as  it  is  to  leave  him 
brooding  over  his  infirmities.  Pride  should  be 
aroused.  Often  pride  in  work  leads  to  pride 
in  personal  appearance. 

Teachers  are  at  first  often  confused  by  the 
difference  in  the  workings  of  the  mind  in  old 
people  and  in  children.  The  tendency  with 
children  is  to  tear  things  to  pieces  to  see  how 
they  work,  and  they  are  commonly  indifferent 
about  putting  them  together  again.  Experi- 
ence of  life  and  habit  make  the  old  want  to 
build  up,  to  construct  rather  than  take  apart. 
They  are  always  anxious  to  see  their  work 
completed.  Work  which  requires  much  plan- 
ning, and  of  which  it  is  hard  to  construct  a 
mental  picture,  confuses  the  old.  Occupation 
should  be  pleasurable,  and  it  is  not  pleasurable 
if  it  bewilders  the  worker.  Work  should  not 


WORK  WITH  THE  AGED  165 

be  too  restful.  Rest  and  quiet  are  not  gen- 
erally needed  so  much  as  a  wholesome  interest. 
The  teacher  may  find  it  hard  to  waken  in- 
terest in  work  that  is  soft  in  color.  It  is  hard 
to  rouse  sense  perception,  and  vivid  colors  may 
not  appear  vivid  to  the  old  student.  Some- 
times it  is  well  to  explain  that  the  people  who 
buy  the  work  like  dull  colors.  Tact  and  com- 
mon sense  are  necessary  in  dealing  with  old 
people,  and  an  appeal  to  the  reason  is  gen- 
erally met  with  a  prompt  response. 


X 

NEURASTHENIA 

THE  most  puzzling  problem  confronting  the 
inexperienced  teacher  in  dealing  with  asthenic 
patients  is  the  difficulty  of  rousing  interest. 
Perhaps  it  is  as  well  to  let  this  question  go 
until  the  patient  is  started  on  the  road  to  re- 
covery, and  simply  carry  out  the  doctor's 
prescription  as  to  a  certain  amount  to  be  ac- 
complished. The  inability  to  become  inter- 
ested is  part  of  the  lack  of  initiative  and  power 
to  execute  which  are  characteristics  of  the  dis- 
ease. Mental  and  physical  forces  are  often  at 
a  low  ebb,  and  interest  is  often  unattainable, 
no  matter  how  much  the  patient  may  want  to 
become  interested,  or  how  conscientiously  she 
may  try  to  fix  her  attention  on  her  work.  The 
teacher  should  consider  lack  of  interest  as  a 
passing  phase  of  the  disease.  It  sometimes 
occurs  that  physical  strength  returns,  so  that 
the  patient  can  take  long  walks,  play  golf,  or 

166 


NEURASTHENIA  167 

even,  in  the  writer's  experience  with  neuras- 
thenics, saw  wood  for  an  hour  at  a  time,  and 
yet  be  completely  floored,  almost  panic- 
stricken,  at  being  asked  to  plan  a  simple  piece 
of  manual  work.  Men  especially  are  often  a 
puzzle  to  the  teacher  in  this  respect.  Some- 
times an  entering  wedge  of  efficiency  can  be 
inserted  through  some  familiar  work,  in  which 
the  patient  has  been  heretofore  so  proficient 
that  his  habitual  skill  helps  him  out,  without 
any  great  mental  effort.  Typewriting  is  a 
good  example.  Most  business  men  know  how 
to  use  the  typewriter,  and  it  seems  to  them  a 
natural  thing  that  they  should  be  asked  to  type 
their  own  letters,  or  help  with  hospital  work. 
Very  little  of  that  train  of  doubting  thought 
is  aroused,  which  is  so  worrisome  to  the  patient 
and  precedes  almost  every  volitional  act.  The 
usefulness  of  the  work  frequently  appeals  to 
a  latent  sense  of  practicality,  which  can  gen- 
erally be  reached  in  a  neurasthenic  man  if  the 
teacher  digs  deep  enough. 

Women  patients  frequently  benefit  from 
weaving  on  a  loom.  It  requires  some  degree 
of  attention,  not  too  much,  and  is  distinctly  in- 
teresting. It  can  be  planned  easily  so  that  the 


168  THE  WORK  OF  OUR  HANDS 

difficulty  decreases  from  day  to  day.  Pro- 
gression in  work  is  quite  necessary  with  this 
type  of  patients. 

The  teacher  cannot  disregard  all  the  pa- 
tient's symptoms.  She  must  use  tact  as  well 
as  skill.  For  instance,  many  neurasthenics 
complain  of  a  blurred  vision  and  inability  to 
see  colors  vividly,  others  are  peculiarly  sensi- 
tive to  harsh  colors  and  much  distressed  by 
piercing  sounds.  Allowance  can  easily  be 
made  by  the  teacher  to  give  the  patients  a 
quiet  place  to  work  at  first,  and  a  good  choice 
of  colors  and  the  conditions  can  gradually  be 
changed  to  reach  the  normal,  as  the  patients 
gain  and  grow  accustomed  to  work.  It 
should  never  be  forgotten  by  the  teacher  that 
she  is  dealing  with  a  disease  that  is  very  diffi- 
cult to  cure,  and  if  the  work  is  part  of  the  cure 
is  must  be  given  with  as  much  scientific  knowl- 
edge as  are  medications  or  baths.  This  does 
not  mean  that  if  a  patient  works  three  hours 
to-day,  she  must  work  the  same  time  to-mor- 
row; it  may  mean  that  to-morrow  being  a  bad 
day,  she  should  work  only  two  hours,  or,  if  she 
seems  much  better  and  more  interested,  she 
may  work  four  hours.  Common  sense  must 


NEURASTHENIA  169 

underlie  the  application  of  all  rules.  The 
teacher's  steadiness  of  purpose,  and  confidence 
in  the  patient's  ultimate  recovery,  generally 
has  an  influence  in  suggesting  hopeful  trains 
of  thought,  even  where  there  is  no  word  of  dis- 
cussion of  illness  ever  allowed.  The  question 
often  arises  as  to  whether,  in  view  of  the  ina- 
bility to  take  responsibility  being  a  part  of 
neurasthenia,  it  is  not  a  good  plan  to  try  to 
overcome  this  by  making  a  neurasthenic  help 
in  teaching  or  in  the  care  of  others.  The 
writer's  experience  has  been,  that  while  suf- 
ferers from  mental  diseases  frequently  benefit 
greatly  from  having  responsibility  put  on 
them,  neurasthenics,  unless  almost  well,  are 
more  likely  to  hurt  themselves  than  they  are  to 
benefit  others.  A  teacher's  report  on  such  a 
case  is  given  below: 

Matron,  aged  36,  spent  about  six  months 
in  the  hospital.  The  first  day  I  heard  her  tell 
the  physician  that  she  knew  all  about  what 
was  the  matter  with  her;  what  she  wanted  was 
for  him  to  help  her  cure  herself.  She  took  the 
whip  hand  in  the  same  way  in  regard  to  occu- 
pation work,  and  the  physician  ordered  the 
teacher  to  let  her  do  what  she  chose.  She  se- 


1TO  THE  WORK  OF  OUR  HANDS 

lected  a  very  intricate  bag  of  knotted  raffia 
work,  hard  on  the  eyes,  and  so  elaborate  as  to 
be  very  trying  to  work  at  steadily.  She  took 
this  to  her  room  at  the  physician's  suggestion, 
and  tired  herself  out  so  that  she  was  unable  to 
do  any  more  occupation  work  for  some  days. 
She  was  then  willing  to  be  guided  by  the  teach- 
er's advice,  and  started  a  sewed  basket,  but  she 
was  able  to  raise  all  sorts  of  difficulties  over 
this;  she  could  not  get  smooth  enough  raffia; 
her  reed  broke  easily.  The  basket,  when  at 
last  completed,  was  a  beautiful  piece  of  work, 
but  she  at  once  gave  it  away,  as  she  said  it  had 
caused  her  so  much  anxiety  she  never  wanted 
to  see  it  again.  She  had  the  same  attitude  to- 
ward other  people's  work  that  she  had  toward 
her  own — perfection  of  technique  was  her  only 
standard,  and  she  constantly  discouraged  other 
patients  who  were  working  happily,  if  some- 
what clumsily,  and  made  them  feel  themselves 
awkward  and  inexpert.  The  idea  that  the  ef- 
fort might  be  valuable  where  the  result  was 
only  fair  technically,  was  one  she  could  not 
grasp.  (She  had  been  for  years  a  retoucher 
of  lantern  slides  for  stereopticon  lectures,  and 
perfection  was  her  hobby.)  Her  physician 


NEURASTHENIA  171 

talked  to  the  teacher  about  her,  sometimes  he 
stopped  her  work  for  a  time,  and  finally  he 
suggested  that  she  be  encouraged  to  feel  her- 
self valuable  in  helping  other  patients.  The 
teacher  and  nurse  tried  to  be  tactful  in  making 
her  feel  herself  very  useful,  although  they  did 
all  the  real  work,  and  in  about  two  days  she 
reported  to  her  physician  that  the  occupation 
teacher  and  the  nurse  were  shirking,  and  let- 
ting her  do  their  work.  She  also  wrote  a 
sharp  note  to  the  occupation  teacher  and  said 
that  she  was  doing  the  work  the  teacher  was 
paid  for,  and  even  reported  this  to  the  super- 
intendent, much  to  the  embarrassment  of  the 
physician,  who  decided  that  the  patient  had 
outlived  the  good  of  hospital  residence,  and 
shortly  after,  following  a  week  in  bed  from 
over-fatigue,  sent  her  home.  She  was  able  to 
return  to  her  vocation  in  a  few  weeks.  This 
was  an  extreme  case,  but  represents  a  type  of 
half-sick  patients  who  are  a  peculiarly  difficult 
problem  for  the  occupation  teacher.  While 
such  an  incident  should  not  be  taken  too  seri- 
ously, it  is  really  worth  careful  thought.  This 
woman  was  kind-hearted,  and  meant  well  to 
the  other  patients;  her  meticulous  devotion  to 


172  THE  WORK  OF  OUR  HANDS 

perfection  of  work  was  an  outcome  of  years  in 
a  vocation  demanding  it. 

The  result  of  trying  to  have  her  help  was  to 
show  how  ill  she  really  was,  as  she  could  not 
rise  to  so  simple  a  situation  without  great  dis- 
turbance. 

Another  patient,  who  seemed  reasonably 
able  to  work,  rebelled  against  doing  anything, 
and  said  she  "only  worked  because  she  was 
made  to."  She  seemed  very  intelligent,  be- 
came in  a  few  hours  quite  interested  in  a  com- 
parison of  various  styles  of  basketry,  decided 
she  could  do  work  as  good  as  any  samples  in 
the  workroom,  and,  after  that,  worked  six  or 
seven  hours  a  day,  evidently  without  fatigue, 
as  the  physician  said  she  slept  better  for  hav- 
ing worked  hard.  Her  attention  was  success- 
fully diverted  from  her  illness.  The  effect, 
however,  reached  no  further  than  this ;  she  took 
no  interest  in  what  other  patients  were  doing, 
was  particularly  annoyed  because  children 
were  allowed  to  work  in  the  same  room  with 
her,  although  she  had  been  a  teacher  and  might 
naturally  be  supposed  to  like  children. 

In  many  cases  it  has  seemed  to  the  occupa- 
tion teacher  that  patients  really  needed  to 


NEURASTHENIA  173 

work  alone  at  first,  but  her  judgment  in  this 
case  was  quite  the  opposite.  This  woman 
needed  to  be  taught  to  be  respectful  of  others' 
rights.  The  presence  of  others  did  not  seem 
to  really  disturb  her,  as  she  did  not  appear  con- 
fused or  easily  tired,  and  the  excellence  of  her 
work  showed  that  she  was  in  fair  condition 
physically.  She  was  the  true  old-fashioned 
type  of  "malade  imaginaire."  It  may  be 
stated  parenthetically  that  her  physician 
pumped  enough  common  sense  into  her  so  that 
she  went  home  at  the  end  of  a  week  "cured." 
One  case  that  seems  to  illustrate  the  possi- 
bilities of  occupation  work  for  neurasthenics 
was  that  of  a  young  man,  a  stenographer, 
broken  down  in  the  financial  crisis  of  1907;  he 
was  pale  and  thin,  and  became  easily  tired,  so 
that,  at  first  the  work  he  did  had  to  be  such  as 
required  the  lowest  degree  of  physical  strength 
and  of  planning.  He  first  made  a  pierced 
brass  ink  well,  bought  stamped  ready  to  deco- 
rate. As  he  had  never  done  any  kind  of  craft 
work,  the  novelty  of  it  attracted  him.  He 
next  made  a  basket  in  Indian  work,  that  is 
made  with  raffia,  with  a  needle,  over  a  foun- 
dation of  reed.  By  the  time  this  was  done 


174  THE  WORK  OF  OUR  HANDS 

he  had  more  control  of  his  hands,  and  was  also 
able  to  plan  out  what  he  wanted  to  do.  He 
planned  a  scrap  basket  with  a  wooden  bottom, 
made  by  himself,  decorated  around  the  top 
with  a  band  of  color.  By  this  time  he  really 
enjoyed  his  work.  After  this,  he  drew  a  wood 
carving  design  for  a  box  and  carved  the  top 
panel.  When  he  was  able  to  go  home,  he  ex- 
pressed himself  as  having  got  a  new  attitude 
toward  work,  and  that  he  would  like  to  make 
more  use  of  his  physical  powers,  and  would 
like  to  build  a  bungalow.  A  more  active  and 
manly  kind  of  life  had  evidently  opened  itself 
up  before  him,  where  he  could  still  make  use 
of  the  dexterity  and  quickness  which  had  for- 
merly been  used  only  in  typewriting.  For  a 
time  he  worked  with  a  surveyor's  corps,  lead- 
ing an  active  outdoor  life.  This  young  man 
cooperated  intelligently  with  his  physician  and 
with  the  teacher,  in  regard  to  the  occupation 
work;  trained  to  systematic  habits,  he  kept 
them  even  in  this  serious  illness. 

Among  other  men  patients  taught,  one  had 
never  come  in  contact  with  real  work,  although 
he  was  a  man  over  forty.  His  physician  asked 
that  he  be  roused  to  take  an  interest  in  several 


PSYCHASTHENIA  175 

kinds  of  work.  At  first  he  was  rather  un- 
willing to  try,  became  easily  fatigued,  and 
paid  little  attention  to  anything  outside  his 
own  condition.  But  he  must  have  had  a  natu- 
ral aptitude  for  hand  work,  as  he  gained  rap- 
idly in  proficiency,  and  (as  he  happened  to 
be  associated  with  some  patients  who  earned 
their  living  as  artisans)  he  got  a  new  attitude 
toward  manual  labor,  which  he  himself  said 
he  had  never  had  before.  He  appeared  to  be 
naturally  delicate  and  had,  perhaps,  always  led 
a  sheltered  life,  so  that  this  was  the  first  time 
he  had  felt  the  satisfaction  of  using  his 
strength  in  honest  work. 

Psychasthenia 

This  caption  covers  such  a  wide  range  of 
humanity  that  we  cannot  expect  to  do  more 
than  generalize.  Often  the  nervous  instabil- 
ity which  makes  the  individual  a  prey  to 
fatigue,  to  distressing  thoughts,  and  to  periods 
of  low  vitality  finds  a  natural  balance  in  work. 
Successful  physical  effort  seems  to  satisfy  and 
benefit  these  patients  by  relieving  the  nervous 
tension.  The  work  done  must  be  restful 
rather  than  stimulating  or  it  fails  of  its  effect. 


176  THE  WORK  OF  OUR  HANDS 

It  is  in  relation  to  patients  of  this  type  that 
there  would  seem  to  be  a  peculiar  field  in  the 
higher  applied  arts,  requiring  creative  power 
and  dexterity,  and  some  strength.  It  might 
be  that  many  could  thus  reach  their  maximum 
of  mental  and  bodily  health,  and  avoid  recur- 
ring setbacks  from  ill  health. 

The  attitude  of  these  patients  towards  work 
is  generally  one  of  keen  interest;  frequently 
they  are  over-enthusiastic.  Occasionally  this 
intensity  of  interest  is  due  to  a  desire  on  the 
patient's  part  to  do  something  that  will  keep 
her  from  too  much  thinking  of  her  health,  or 
whatever  dominant  idea  had  her  in  its  clutches. 
In  other  cases  it  is  due  to  a  genuine  interest  in 
the  work  in  hand,  and  it  seems  that  this  nor- 
mal interest  is  not  disturbed  by  illness.  It  is, 
however,  often  necessary  to  hold  back  patients 
from  working  too  long  and  too  steadily.  The 
desire  to  complete  work  seems  to  be  too  keen. 
The  mind  seems  to  leap  far  ahead  of  what  the 
body  can  accomplish,  and  the  impression  the 
teacher  gains  is  that  these  patients  need  rest- 
ful guidance  rather  than  stimulation.  In  fact, 
what  gain  is  derived  from  occupation  work 
seems  to  be  from  mechanical  work,  rather  than 


PSYCHASTHENIA  1T7 

from  that  requiring  creative  power.  This  ap- 
plies to  patients  so  ill  as  to  require  hospital 
care.  The  most  engrossing  of  craft  work,  re- 
quiring the  keenest  use  of  the  creative  power, 
probably  never  cause  a  "nervous  breakdown" 
such  as  are  often  attributed  to  teaching  and 
other  vocations  where  the  human  element 
enters  in. 

A  few  examples  may  illustrate  the  teaching 
of  these  cases.  One  of  these  was  a  school- 
teacher of  about  thirty  who  had  been  in  school 
work  twelve  years,  and  had  had  several  break- 
downs, when  she  could  not  sleep  or  eat.  Her 
attention  was  entirely  taken  up  with  her  own 
condition,  physical,  mental  and  moral.  She 
spent  many  hours  a  day  thinking  over  her  re- 
ligious beliefs,  and  talking  about  them  if  she 
could  get  any  one  to  listen.  So  absorbed  was 
she  in  this  self -analysis,  that  rules  forbidding 
conversation  about  one's  ills  were  entirely  for- 
gotten. When  allowed  to  work,  she  plunged 
into  basketry  and  wanted  to  work  before 
breakfast  and  late  at  night.  The  teacher 
switched  her  off  onto  chair  caning,  which  be- 
ing somewhat  monotonous  and  mechanical, 
seemed  to  quiet  her  at  once.  The  difficulties 


178  THE  WORK  OF  OUR  HANDS 

presented  were  sufficient  to  hold  her  attention, 
but  not  over  stimulating.  She  caned  eight 
chairs  in  a  fortnight,  and  soon  after  was  able 
to  return  home. 

Another  patient,  a  trained  nurse  of  about 
50,  had  much  the  same  restless  activity. 
Her  physical  condition  was  the  subject  of  her 
depressing  thoughts,  but  she  also  was  amen- 
able to  discipline  through  manual  work.  She 
became  interested  in  basketry,  and  it  had  the 
same  effect  in  restoring  her  balance  that  chair 
caning  had  on  the  first-mentioned  patient. 
She  became  a  successful  teacher  of  craft  work 
in  a  Boys'  Club. 

A  third  case  of  peculiar  interest  is  that  of  a 
young  woman  of  about  30,  so  delicate  that 
she  had  constant  nervous  attacks  if  she  at- 
tempted, as  she  put  it,  to  "live  like  other  peo- 
ple." She  decided  to  spend  one  winter  under 
the  care  of  a  nerve  specialist  to  "learn  how  to 
live."  She  wanted  work  to  occupy  an  hour  or 
two  a  day  and  chose  basketry,  deciding  to  make 
one  really  beautiful  sewed  basket.  At  first 
she  could  work  only  a  few  minutes,  and  the 
teacher  had  to  help  her  plan  the  design. 
Later,  she  elaborated  the  original  design  and 


PSYCHASTHENIA  179 

introduced  more  colors.  The  basket,  when 
completed,  was  really  a  work  of  art  and  the 
patient  calculated  it  had  filled  more  than  two 
hundred  hours.  She  meanwhile  had  gained 
so  in  strength  and  became  so  much  interested 
in  craft  work,  that  she  decided  to  take  a  course 
in  book-binding,  and  has  made  a  great  success 
of  it.  This  is  a  type  of  person  who  knows  she 
has  inherited  a  neuropathic  temperament  and 
is  systematically  trying  to  fortify  herself,  with 
good  results. 


XI 

WORK  WITH  CRIPPLES 

THE  crippled  and  the  blind  were  among  the 
first  to  demonstrate  the  possibilities  of  handi- 
craft work  as  a  means  of  livelihood.  Wher- 
ever work  was  started  it  became  almost 
immediately  successful.  The  results  of  early 
attempts  at  training  cripples  in  Europe  and 
this  country  have  been  carefully  studied  so 
that  it  can  be  estimated  with  a  fair  degree  of 
accuracy  what  work  should  be  possible  for  one 
limited  by  any  particular  handicap,  such  as 
the  loss  of  a  hand  or  a  foot.  / 

Among  the  European  countries  which  took 
up,  many  years  ago,  scientific  work  with  the 
crippled  and  injured,  was  little  Denmark. 
Reverend  Hans  Knudsen  in  1872  opened  a 
clinic  and  school.  The  aim  of  this  clinic  was 
"ameliorating  the  corporal  deformity  of  the 
cripple,  and  afterward  by  means  of  an  indus- 
trial school,  teaching  him  how  to  work,  so  that 

180 


WORK  WITH  CRIPPLES  181 

be  might  contribute  to  his  own  sustenance." 
The  Government  backed  him  financially 
shortly  after  he  started  in  this  work,  and  he 
aimed  from  the  outset  to  help  every  cripple  in 
the  confines  of  Denmark.  In  one  of  the  re- 
ports of  this  school  the  following  statement 
occurs : 

"The  cause  of  the  deformed  is  taken  up  all 
over  Denmark  with  the  greatest  sympathy, 
which  finds  expression  in  many  ways.  Most 
daily  papers  insert  advertisements  free  of 
charge.  The  annual  report  is  printed  for 
nothing,  nor  is  any  charge  made  for  telephone, 
paper,  medicine,  hospital  treatment,  etc." 

The  output  from  this  school  is  bought  not 
only  by  private  individuals,  but  by  the  Govern- 
ment. The  railways  buy  linen  and  cotton 
goods,  furniture,  brushes,  etc.,  and  the  street 
cleaning  departments  buy  brushes. 

After  the  success  of  the  Danish  school  was 
assured,  Pastor  Knudsen  longed  to  bring  hap- 
piness and  financial  help  to  cripples  in  other 
countries.  In  1884  an  International  Con- 
gress of  Physicians  held  in  Copenhagen 
brought  many  visitors,  and  an  opportunity 
was  given  to  show  the  work  done.  A  new 


182  THE  WORK  OF  OUR  HANDS 

school  was  soon  started  in  Gothenburg, 
Sweden,  in  which  weaving,  printing,  and  book- 
binding are  among  the  industries  taught. 
The  making  of  orthopaedic  boots,  braces,  and 
other  hospital  appliances  is  also  very  satisfac- 
torily done.  Pupils  who  have  completed  their 
course  in  the  school  and  learned  a  trade  are 
sometimes  given  a  set  of  tools  to  work  at  home. 
It  is  said  that  there  is  no  cripple  who  could 
possibly  become  self-supporting  left  untrained 
in  Scandinavia.  In  addition  to  the  benefit 
from  learning  trades,  these  cripples  gained 
much  physically. 

In  England  the  schools  have  been  con- 
ducted on  a  somewhat  different  principle, 
small  children  being  taken  as  pupils  and  given 
therapeutic  gymnastics  and  craft  training  up 
till  the  age  of  sixteen.  Jewelry  work,  tailor- 
ing and  harness  making  are  among  the  trades 
taught. 

Many  schools  in  this  country  have  been  con- 
ducted successfully  on  a  somewhat  similar 
principle,  the  only  difference  being  in  the  fact 
that  the  graduates  frequently  continue  to  work 
in  the  school  workshop,  instead  of  carrying  on 
their  trades  at  home.  As  many  of  them  live 


OCCUPATION"    ROOM    AT   HOSPITAL   FOR    RUPTURED 
AND  CRIPPLED,   NEW  YORK  CITY. 

Such  a  great  room  as  this  could  be  utilized  for  large  classes  of 
crippled  workers  coming  in  from  outside  for  daily  work 
and  treatment. 


WORK  WITH  CRIPPLES  183 

in  tenements,  it  goes  without  saying  that  em- 
broidery and  many  other  trades  can  be  better 
done  at  the  school* x 

The  Hospital' of  Hope  in  the  Bronx,  New 
York  City,  under  the  enthusiastic  direction  of 
Dr.  Jaeger,  is  an  enterprise  on  a  somewhat 
more  scientific  basis,  in  that  it  aims  to  train 
young  men  between  the  ages  of  sixteen  and 
thirty-five  in  skilled  trades,  especially  chosen 
with  regard  to  individual  handicaps.  These 
workers  can  then  carry  on  their  trades  in  any 
shop  where  they  can  get  positions.  Among 
the  work  done  is  reed  and  willow  furniture 
making,  cabinet  making,  silver  smithing, 
monograms  and  wood  engraving,  die  work, 
show  card  writing,  and  mechanical  drawing. 
The  men  who  enter  the  school  must  be  able  to 
walk,  but  the  loss  of  one  hand,  or  one  foot, 
does  not  make  the  applicant  ineligible.  The 
work  that  seems  the  most  remarkable  to  the 
general  observer  is  that  done  in  art  glass,  or 
mosaic  work,  by  one-handed  men.  A  treadle 
operated  by  the  foot  is  used  in  placing  the 
work.  Small  pieces  of  glass  are  used  to  form 
the  design.  This  is  one  of  the  most  lucrative 
trades  taught. 


184  THE  WORK  OF  OUR  HANDS 

One  great  difficulty  met  with  in  the  train- 
ing of  adult  cripples  is  the  restoring  of  self- 
confidence.  So  many  seem  to  have  "lost  their 
grip,"  and  feel  thejnselves  far  more  incapable 
than  they  are./^Bpecial  attention  has  been 
paid  to  this  phase  of  the  subject  in  the  chap- 
ters on  Reeducation  and  on  Tabes/  The  same 
thing  is  true  in  regard  to  those  crippled  by 
accident,  and  it  is  well  to  have  as  short  an 
interval  as  possible  between  discharge  from 
hospital  care  and  the  beginning  of  training. 
This  is  one  of  the  best  arguments  for  trade 
work  in  hospitals. 

The  teaching  of  crippled  children  must 
necessarily  be  done  with  great  care.  In  the 
case  of  Infantile  Paralysis,  it  may  be  com- 
bined with  physical  exercise  in  order  to  get 
the  best  therapeutic  effect.  This  has  already 
been  touched  on  in  the  chapter  on  Paralysis. 
In  the  work  with  children  suffering  from  bone 
tuberculosis,  Potts'  Disease  or  hip  disease,  the 
physician  may  be  able  to  predict  how  much  de- 
formity must  be  allowed  for,  so  that,  if  the 
child  is  liable  to  be  permanently  misshapen, 
work  requiring  little  strength  may  be  given. 


WORK  WITH  CRIPPLES  185 

frequently  these  children  have  great  delicacy 
of  touch,  and  a  keen  color  sense,  and  these 
characteristics  may  be  made  use  of  in  planning 
work* 


APPENDIX 

As  an  example  of  the  variety  and  the  extent 
of  the  work  done  in  one  state  hospital — The 
State  Colony  for  the  Insane,  at  Gardner, 
Massachusetts — the  following  list  of  manufac- 
tures and  products  is  copied  from  the  Annual 
Report  for  1914. 

The  State  Colony  at  Gardner  is  above  the 
average  in  industrial  efficiency,  but  the  possi- 
bilities of  production  have  only  begun.  A 
very  small  proportion  of  the  farm  is  utilized  in 
any  way  and  many  possible  industries  are  cur- 
tailed or  omitted  for  lack  of  support  or  funds. 

INDUSTRIAL  DEPARTMENT 
WORK  DONE  BY  WOMEN 

Aprons,    dining-room...  110  Bags,  candy,  Christmas.  117 

Aprons,   gingham 42  Bags,  coffee   51 

Aprons,    kitchen 258  Bags,  Irish  crocheted...  4 

Aprons,  white 70  Bags,  jelly 6 

Babies'  bib,  embroidered  1  Bags,  laundry 170 

Baby's  pillow  tops,  em-  Bags,    tea 49 

broidered   2  Bags,  twine,  laundry. ...  31 

187 


188 


APPENDIX 


Bags,  twine,  school 12 

Baskets,  raffia 114 

Baskets,  reed 14 

Bibs    136 

Bibs,  apron 6 

Blankets,  hemmed 1T6 

Books  covered,  library . .  80 

Bonnets   2 

Brush  and  broom  cases, 

embroidered   4 

Bureau      covers,      hem- 
stitched      133 

Burial    robes 24 

Canvas  pillow  support. .  1 
Canvas        covers        and 
swings   for  continuous 

bath    2 

Caps,  cloth 4 

Caps,  corduroy 56 

Case    for    rubbers,    em- 
broidered      1 

Cases,   leather,   medicine 

bottle   5 

Chemises    281 

Chemise      yokes,      Irish 

crocheted    4 

Coats  (men  patients)  . . .  133 

Coats    (women  patients)  4 
Collar  and  cuff  sets,  Irish 

crocheted  2 

Collar,  Irish  crocheted..  1 
Collar    and    yoke,    Irish 

crocheted  1 

Corset  covers 26 

Covers,  baseball  base  ...  3 

Cover,  blasting  mat, ....  1 

Covers,  broom 6 

Covers,  canvas  buffers . .  79 
Covers,      dentist      chair 

hand  rest..  34 


Covers,      cotton      floor, 

painters'  5 

Cover,  printing-press ...  1 

Covers,  requisition  book.  60 

Covers,  screen,  hospital.  12 
Crocheted  beading  and 

cord  (yards) 9 

Crocheted  doilies,  table.  6 

Crocheted  napkin  rings.  18 
Crocheted  slippers 

(pairs)  7 

Curtains,  scrim  (pairs).  131 
Curtains,  dressing-room, 

khaki  2 

Curtain  ties  (pairs)....  39 

Cushion  covers 9 

Doilies,  hemstitched 3 

Dolls,  dexter  cotton 14 

Drawers,  cotton,  pa- 
tients'    224 

Dresses,  patients' 651 

Embroidered  boudoir  cap  1 
Embroidered  bureau 

scarfs  4 

Embroidered  center 

pieces  7 

Embroidered  collar  and 

cuff  sets 5 

Embroidered  collars 2 

Embroidered  doilies 58 

Embroidered  lunch  cloth  1 

Embroidered  neckties. ...  6 
Embroidered  pillow 

cases 24 

Embroidered  pillow  tops  7 

Embroidered  pincushions  8 

Embroidered  table  covers  12 
Embroidered  waists, 

voile  5 

Golf  capes 17 


APPENDIX 


189 


Handkerchiefs  (dozen)..  19 
Handkerchiefs,  crocheted 

edge 3 

Handkerchiefs,  hem- 
stitched    23 

Hats,  palm-leaf 139 

Holders,  kitchen 282 

Jabots,  Irish  crocheted . .  2 

Jumpers  310 

Kimono 1 

Lace,  knitted  (yards)  . . .  37£ 
Lunch     sets,     crocheted 

(20  pieces  in  set) 4 

Mattress  cases 79 

Mats,  Colonial  (3  pieces 

in  set) 45 

Mittens    (pairs) 704 

Napkins,  sanitary 264 

Napkins,  table 342 

Neckties   181 

Neckties,  crocheted 2 

Nightgowns   417 

Overalls 984 

Padded     aprons,      dish- 
washers    3 

Pillow  cases 587 

Pillow  tops 8 

Pillow      shams,      drawn 

work  2 

Rags,    sewed    for    rugs 

(pounds)    1,725 

Reefers    28 

Rugs,  braided 183 

Rugs,  hooked 17 

Rugs,  woven 145 

Scrim      curtains,      hem- 
stitched      33 


Shawl,  knitted 1 

Sheets,  officers 145 

Sheets,  patients 1,820 

Shirts,  hospital   62 

Shirts,  outside 504 

Shirtwaists    8 

Shoe  tops,  stitched 

(pairs)     697 

Sideboard    covers,    hem- 
stitched      3 

Sideboard    covers,    hem- 
stitched, drawn  work.  2 

Skirts,  dress   6 

Slippers,  crocheted 

(pairs)     2 

Socks  toed  (pairs)   3,116 

Stand  covers    35 

Suspenders   (pairs)    ....  818 

Tablecloths    39 

Table  covers,  hemstitched  43 

Table  covers,  plain 45 

Tag  case  7 

Tatting  collars    11 

Tatting  doilies 5 

Tatting  edge  and  inser- 
tion (yards)   10 

Towels,  embroidered   ...  5 

Towels,  hemmed   5,840 

Tray  cloths 27 

Trousers   (pairs)    922 

Underskirts    601 

Upholstered  cushion  lin- 
ings      4 

Vests    88 

Wash  cloth,  embroidered  1 

Window  shades  stitched.  211 

Worsted  Santa  Claus  . ,  24 


190 


APPENDIX 


MENDING 


Aprons   172 

Bags,  tea  and  coffee 8 

Barber's  chair  cover....  1 

Baseball  pants    10 

Bedspreads    6 

Blanket,  bed,  cotton  ....  1 

Bureau  cover 1 

Cape    1 

Caps    50 

Chemises   64 

Coats,  men's 1,391 

Corset  covers 23 

Curtains    12 

Dishwashing  pads 6 

Drawers   115 

Dresses   976 

Flags    14 

Gloves  (pairs)   3 

Horse  blankets  4 

Jumpers    491 

Kimonos    2 

Laundry  bags   37 


Mittens  (pairs)  221 

Nightgowns    322 

Nightshirts   47 

Oilcloth  table  covers   ...       13 

Overalls  1,761 

Overcoats    2 

Petticoats    542 

Pillow  slips    2 

Reefers    70 

Rugs    9 

Sheets 24 

Shirts,  men's,  colored   . .  1,834 

Spreads   8 

Stockings 4,034 

Sweaters    4 

Tablecloths  10 

Tent   1 

Trousers    2,499 

Underdrawers    1,579 

Undershirts    1,180 

Underskirts    12 

Vests    .  312 


WORK  DONE  BY  MEN 
BLACKSMITH  AND  MACHINIST 


Anchor  irons  made 

Andirons  made  (sets)  .. 

Angle  irons  made 

Axe  wedges  made 

Bands,  etc.,  made 

Bitstock  socket  

Bolts  made 

Braces  made    

Braces  straightened  .... 

Bracket  made    

Bunk-irons  made  (set)  . 

Cant  hooks  shaped 

Carriages  repaired 


136  Catches  made 

7  Chafe  irons  made 

264  Chain  and  toggle  made. 

12  Chains  made    

8  Chains  repaired    

1  Chisels  made    

505  Chisel  sharpened 

83  Clamps  made 

2  Clevis  made    

1  Coal  shovel  repaired . . . 

1  Crowbars  made 

3  Crowbars  sharpened  . . . 
6  Cultivators  repaired  . . . 


4 

4 
1 
5 

80 
2 
1 

14 
1 
1 
4 

61 
4 


APPENDIX 


191 


Cut   and   flange    (1-inch 

pipe,  for  steps) 1 

Cutting  piece  of  smoke- 
stack    1 

Damper  iron  made 1 

Door  guides  made 2 

Door  latch  made 1 

Doorstep  repaired   1 

Draw  irons  made 3 

Eyebolts  made 7 

Eyelets  made 5 

Evener  made  

Evener  repaired   

Evener  staple  made 

Fertilizer     spreader     re- 
paired     

Flag-pole  ring  made .... 

Gambrel  made 

Garden  basket  legs  made  4 

Gear  pullers  made 2 

Grass  hooks  repaired  ...  2 

Grate  lifter  made 1 

Grub  hoes  sharpened. ...  11 

Hames  repaired 2 

Hammer  strap  made 1 

Hammer  wedges  made. .  24 

Hangers  made 50 

Harrows  repaired 10 

Hasps  made 2 

Hay  hooks  made 3 

Hinges  made  16 

Hinges  repaired  3 

Hoes  repaired  2 

Holes  drilled  602 

Hooks  made 34 

Horses  shod  152 

Horse  shoes  set 36 

Horse  shoes  sharpened . .  10 

Ice  plow  repaired 1 

Ice  tongs  made  (pair)  . .  1 


Ice  tongs  repaired  (pair)  1 

Iron  gate  made 1 

Iron  plate  made 1 

Iron  stakes,  fence,  made  10 

Irons  straightened 2 

Lamp  clamp  made 1 

Latches  and  bolts  made.  3 

Light  protectors  made  . .  16 

Links,  chain,  made 8 

Manure     spreaders     re- 
paired      3 

Meat  saw  repaired 1 

Mowing     machines      re- 
paired      2 

Neck  yokes  made 10 

Neck  yokes  repaired....  2 

Oxen  shod 142 

Ox  yokes  repaired 7 

Payout  reel  made 1 

Picks  resteeled    47 

Picks  sharpened  234 

Pinch  bars  sharpened...  2 

Pipe  rests  made 6 

Plows  repaired  2 

Plow  rod  repaired 1 

Pole   end   iron   and   pin 

made    1 

Potato  parer  repaired ...  1 

Presser  foot  arm  made . .  1 

Punch  made 1 

Remnant    bag    supports 

made 2 

Ring  bolts  made 2 

Rings  made   40 

Rods  bent 42 

Rods  made  208 

Rods  straightened    2 

Saw  handles  repaired ...  2 

Scale  repaired  1 

Screw  driver  repaired...  1 


192 


APPENDIX 


Screw  made  1 

Shaft  box  repaired 1 

Shaft  iron  repaired 1 

Shafts  repaired 7 

Shipper  irons  made 3 

Shovels  repaired 3 

Sled  dogs  made 2 

Sleds  repaired  8 

Sled  shod 1 

Sleighs  repaired  4 

Sleighs  shod  5 

Soldering  irons  repaired  3 

Stanchion  irons  made...  16 

Stanchion  latches  made . .  2 

Stanchion  repaired 1 

Staples  made 38 

Stepladder  stays  made . .  2 

Stone  drills  made 23 

Stone  drills  sharpened. .  1,085 
Stone      drill      spoons 

made    3 


Stone    drill    spoons    re- 
paired    3 

Stone  hammers  refaced.  7 

Strap  irons  made 92 

Stripping    hammers    re- 
faced    3 

Sulky  plows  repaired ...  3 

Tailboard  irons  made ....  2 
Tires  made  and  put  on 

wagon    4 

Tires  set,  carriage 6 

Tires  set,  wagon 2 

Trimming  knife  made. . .  1 

Wagons  repaired   8 

Wagon  yoke  made 1 

Washers  made 31 

Welding  (pieces)   3 

Whiffletree  iron  set 1 

Whiffletree  repaired 1 

Window  openers  made..  12 

Wrench  made 1 


BROOM  AND  BRUSH  DEPARTMENT 


Brooms  made 219 

Rattan   12 

Toy  1 

Whisk    1 

Brushes  made: — 

Ceiling  16 

Counter    114 

Floor    130 

Mane  and  tail 50 

Radiator   125 

Scrub   248 

Scrub,  long-handled  . .  41 

Vegetable    320 

Window     67 

Mat,    cocoa    (9    feet    6 


inches   by   6    feet   5 

inches)    1 

Mattresses : — 

Hair  (4-foot)    10 

Hair  (2  feet  6  inches)  65 

Pillows,  hair 38 

Stockings  knitted  (pairs)  514 

Toweling  woven   (yards)  171 
Upholstery: — 
Carriage     backs     and 

seats   2 

Chairs,  arm    6 

Cushions    made,    leather 

(2  feet  by  5  feet)  . .  6 

Sleighs  2 


APPENDIX 


193 


Axe  handles  made 

Bannister  repaired 

Barn  ceiling  repaired... 

Bathroom  platform  re- 
paired   

Box,  book,  made 

Box,  blasting  mat,  made. 

Boxes,  bushel,  made 

Boxes,  half-bushel,  made 

Box,  cheese,  made 

Boxes,  guinea  pig,  made 

Box,  special,  made 

Box,  motor  and  switch, 
made  

Bread  boards  made 

Bread  boxes  repaired. . . . 

Cabinet  benches  made. . . 

Cabinet  closets  made. . . . 

Cart  repaired 

Carriages  repaired 

Chain  guard,  door,  put 
on  

Chair  swing  repaired. . . . 

Chicken  houses  made .... 

Cleat,  flagpole  halyard, 
made  

Clothes  boxes  repaired . . 

Clothes  line  posts  made. 

Clothes  locker  made 

Clothes  rack  repaired... 

Coat  hangers  repaired  . . 

Cold-air  shaft  repaired . . 

Cold  frames,  vegetable, 
made 

Counter,  store 

Counter-motor,  store, 
made  

Crates,  hot-water  heater. 


CARPENTER 

7      Cupboards  made 4 

Door  casings  repaired ...  2 

Door  hung,  barn 1 

Door  jam  repaired 1 

Door  knobs  repaired 3 

Door  spring  repaired...  1 

Doors,  inside,  made 3 

48      Doors  repaired  225 

12      Doors,  screen,  made 6 

1      Drawers  repaired 14 

6      Ensilage  barrow  repaired  1 

1      Evener  made 1 

Extension   ladders   made 

1  (24  feet  each) 6 

2  Fenders,  swing  stage 2 

2      Fertilizer  screen  made..  1 
2      Fertilizer    spreader     re- 

2  paired    1 

1      File  handle  made 1 

3  Flagpoles  made  (60  feet 

high)  2 

1  Flagpole  caps  made 2 

1  Floor,  horse  stall,  made.  1 
15  Floor  polishing  blocks 

made    6 

1  Floors  repaired 7 

2  Floor  swabs  made 9 

2      Frames,  window,  made..  3 

1      Fuse  box,  switch,  made. .  1 

1      Gate,  chicken  coop,  made  1 

10      Grading  stakes  made...  620 

1  Grove  seats  made 18 

Handles,        payout-reel, 

2  made  (set)   1 

1      Harrows  repaired 3 

Hen  houses  repaired. ...  2 

1      Hen  trap  nests  made 24 

3  Hog  troughs  made 2 


194 


APPENDIX 


Horse  stalls  repaired...  12 

Horse  rack  made 1 

Hot-bed  -  frame  sashes 

made  15 

Ice  plow  sharpened 1 

Ice  run  made  (feet) 61 

Ironing  boards  and 

stands  made 5 

Ironing  board  made....  1 

Keys  made  35 

Kitchen  sink  repaired ...  1 
Kitchen  utensil  rack 

made  1 

Lawn  mowers  repaired . .  3 

Locks  put  on 73 

Locks  repaired  295 

Lumber  planed  (feet) ..  1,100 

Meat  board  made 1 

Neck  yokes  made 46 

Overlook  cottage,  built . .  1 

Ox  yokes  repaired 2 

Pantry  shelves  made 

(set)  1 

Partitions  made 2 

Patterns,  casting,  made.  10 

Piano  legs  repaired 4 

Piazza  repaired 1 

Platform  cover  repaired.  1 

Platforms  repaired 2 

Rack,  paper  bag,  made . .  1 

Rack,  time  card,  made . .  1 

Refrigerators  repaired . .  2 

Roofs  repaired  7 

Rubbers  put  in  door 

steps  6 

Sawhorses  made  7 

Saws  filed  200 

Screen  doors  made 5 

Scuif  hole  repaired 1 


Scuttle  repaired   1 

Sections,  strawberry- 
crate,  made 24 

Shelves  made 5 

Shipping  box  made 1 

Shoe  rack  made 1 

Signs  made 24 

Slaughter  house 1 

Sled,  log,  made 1 

Sledge    hammer    handles 

replaced 150 

Sleds  repaired  12 

Sleighs  repaired   2 

Snow  shovels  repaired ...  5 

jStair  railings  repaired..  1 

Stairs  repaired   5 

Stakes,  grade,  made ....  450 

Stanchions  repaired 15 

Step  made  (4-foot) 1 

Stepladders      made       (2 
feet,  4  feet  and  6  feet 

each)    3 

Sticks,      laundry      rack, 

made 24 

Stone  boats  made 36 

Table  shelf  made 1 

Tennis      court      screens 

erected  (feet)    100 

Toilet     paper     box     re- 
paired      1 

Tool  box  cover  made ....  1 

Tool  box  made 1 

Towel  rack  repaired....  1 

Trucks  repaired   2 

Vegetable  boxes  made. .  36 

Ventilator  repaired   ....  1 

Wagon  body  made 1 

Wagons  repaired   4 

Wall  boxes  made 4 


APPENDIX 


195 


Wardrobe  made   

Water  closet  repaired.. 

Whiffletrees  made    

Windmill  repaired  

Window  casing  made 

Window  frames  repaired 
Window  guard  repaired. 
Window  sash  repaired . . 


1  Window  screens  made. .  73 

1  Window  screens  repaired  250 

6      Windows  made  4 

1      Windows  repaired   70 

1  Window  stops  put  on ....  250 

64  Wooden  screen,  bathtub.  1 

1  Wood  rack  made   (10% 

1         by  3y2  feet) l 


FURNITURE  DEPARTMENT  (NEW  WORK) 


Apparatus,  gymnasium, 
set  up  

Bases,  wood  basket 

Baskets,  berry 

Baskets,  office 

Baskets,  wood  

Beds  set  up 

Benches  made  (102*4 
feet)  

Box,  card  index 

Boxes,  drawer,  library 
card  

Boxes,  flower 

Boxes,  flower,  reed 

Boxes,  flower,  with 
stands  

Boxes,  knife    

Boxes,  special  

Boxes,  toilet  paper 

Brackets,  flower  box 

Brass  nosing  put  on  stairs 

Bulletin  board  with  card 
holder 

Cabinet,  phonograph  . . . 

Cases,  thermometer   .... 

Castors,  chair   

Chairs,  dining-room  .... 

Chairs,  patients',  dining- 
room  . 


Chairs,       rattan       rock- 

4  ing    36 

6      Chair  rounds  made 35 

6      Chiffonniers    12 

5  Curtains,   shades,   rollers 

1          and  fixtures   23 

11      Desks,  writing 3 

Diet  board  1 

15      Dressers    7 

1  Forms,  laundry  bag 12 

Frames,  lacework  23 

Q      Frames,  picture   15 

6  Gags,  mouth   23 

4      Handles,   hammer    2 

Jacks,  tailor    2 

2  Key    1 

4      Machines,  power  sewing, 

3  set  up    5 

8      Plugs,  bed 3 

18      Presses,  tailor  3 

18      Racks,  apple  drying 4 

Racks,  book  2 

1      Racks,  laundry  bag 8 

1      Rack,  table  and  pan ....  1 

7  Rack,       table,       24-lock 

36          drawer 1 

36      Racks,  towel   2 

Rods,  flag 12 

46     Rollers,  curtain 5 


196 


APPENDIX 


Rubber    treads    put    on 

stairs    18 

Screens,  bedside  folding.  3 

Shanks,  shoe 1,300 

Shuttles,  loom  10 

Shuttle,  sewing  machine.  1 

Stand,  inkwell  1 

Stools,  foot 2 

Stool,  high   1 

Stools,  milking    6 

Stretcher,  loom  1 

Swift,  loom   1 


Tables,  day  room,  round 

top    8 

Tables,  card 6 

Tables,  folding  6 

Tables,  dining,  officers'..  6 

Tables,  reed  1 

Table,  telephone   1 

Table,  work   1 

Ventilator,  window,  port- 
able    1 

Wands,  gymnasium 18 

Wheelbarrows  assembled  24 


FURNITURE  DEPARTMENT  (REPAIRS) 


Barber's     shears     sharp- 
ened      31 

Baskets,  laundry 9 

Belts,  sewing  machine . .  3 
Belts,     sewing    machine, 

tightened  7 

Benches   25 

Bench,  piano   1 

Billiard  cues   100 

Boxes,  shipping 3 

Boxing,    sewing  machine 

head    1 

Bookcase  1 

Chair,  barber's   1 

Chairs    260 

Clocks    5 

Clocks  set  up 3 

Clocks,    watchman's,    re- 
paired      3 

Couches    5 

Couch  top  reseated 1 

Curtains    12 

Curtains  and  fixtures  set 

up   4 

Curtains  changed 20 

Curtains  hung  41 


Drawers,  sewing  machine  2 

Foot  rest 1 

Frames,  mat    10 

Frames,  picture 12 

Graphophones    4 

Grommets  put  in  canvas  9 

Guns,  wooden,  with  rack  16 

Handles,  floor  brush ....  2 

Handles,  swab,  put  in..  7 

Hooks,  rug,  refiled 6 

Knives  sharpened 51 

Locks  put  on 41 

Looms    6 

Machines,  sewing, 

cleaned 3 

Machines,      sewing,      re- 
paired      32 

Mirror  set  up 1 

Pedal,  organ    1 

Pianolas 3 

Piano  tops    2 

Pool  table,  covered 1 

Potter's  wheel   1 

Pulls,  curtain,  put  on ...  4 

Rods,  curtain 23 

Roller  curtain  .  1 


APPENDIX 


19T 


Rubber   mat   foot   stool, 

dentist    

Saw  filed 

Settees    

Scissors    

Scissors  sharpened 

Stand    


Stools 2 

1      Tables    16 

1      Table,  cutting  1 

26      Tables,  sewing 14 

21      Tray,  letter 1 

93      Wheelbarrows    64 

1  Wheelbarrows  repainted.  7 


MASON 


Brickwork:— 

Bricks  laid,  red1 10,000 

Chimneys  built   3 

Clean-outs  built    9 

Closets  built    2 

Cold-air  boxes  built 2 

Fireplaces   built    2 

Kettles  set   2 

Manholes  built   4 

Piers  built   6 

Refrigerator  built   1 

Cement  work: — 

Cellars  cemented    3 

Cesspool  made 1 

Chimney  caps  made 3 

Coping  made  (60  feet  by 

2  feet  by  6  inches) ...  1 

Cow  barn  floor  put  in . .  1 

Curb  made  (feet) 30 

Door  sills  made 9 

Flagpole  footings  made.  2 

Footings  made    18 

Grain  boxes  made 3 

Hitching  posts   made ...  3 

Ice  landing  made 1 

Mangers   made    2" 

Refrigerator  cemented . .  1 
Reenforced     chimney 
foundation    made    (10 
feet  by  10  feet  by  12 

feet)  1 


Roofs  made 2 

Room  floors  put  in 9 

Silo  fixed 1 

Terrazzo  floors  put  in . .  2 

Trestle  piers  made 2 

Walks     put     in     (cubic 

yards)    30 

Window  sills  made 9 

Miscellaneous : — 

Blasting  (days)  .  50 

Chimneys  cleaned  out ...  6 
Chimney   clean-outs   put 

in 4 

Holes  drilled  in  cement 

floors    100 

Holes    drilled    in    stone 

walls  10 

Range  repaired  1 

Switch  boxes  repaired . .  12 

Thimbles   set    3 

Tile  pipe  laid  (feet)  ....  1,000 

Tile  floors  relaid 6 

Ventilators  put  in 3 

Windows  repaired   12 

Plastering: — 

Chimneys  plastered   ....  3 

Patches  put  on 150 

Plastering      (square 

yards)    900 

Skimming   (square 

yards)    900 


198                                      J 
Walls  plastered  

kPPB 
6 

5 
4 

PAH 

1 
1 
1 
1 

22 
14 
82 
2 
1 
4 
2 
5 
11 
2 
1 
5 
1 
96 
285 
1 
6 
4 
3 
1 
3 
7 
1 
8 
7 
2 
2 

NDIX 
Chimney  built  

1 
3 
1 

20 
6 
1 

3 
1 

66 
4 

2 
7 
4 
4 
2 
1 
4 
639 
2 
1 
2 
6 
2 
3 
8 
12 

2 
5 
2 

14 
6 

2 
5 

Pointing:  — 

Culverts  built   

Ice  house  underpinning. 
Piers  built 

Stone  walls  

Stone  work:  — 

Retaining  walls  built.  .  .  . 
Storehouse  underpinning 

ran 

Eveners  painted  

Ambulance  painted  .... 
Automobile  painted  .... 
Bakery  oven  painted.  .  .  . 
Barber  chair  refinished.  . 
Beds  enameled  

Express  wagon  painted. 
Fence  post  painted         . 

Fire  escapes  painted  .... 
Flagpole  balls  painted.. 
Floors  varnished  

Benches  finished  

Blinds  painted  (pairs). 
Bookcases  finished  • 

Flower  stands  painted  .  . 
Flower  tubs  painted  .... 
Folding  screens  painted. 
Food  truck  enameled  .... 
Game  boards  painted... 
Glass  set   (panes)  

Book  holder  finished  
Bread  boxes  lettered.  .  .  . 
Bread  mixers  painted  .  .  . 
Buildings  painted  inside 
Buildings  painted  outside 
Bulletin  boards  finished. 
Butter  case  finished  
Carriages  painted  .  .  . 

Halls  painted  

Heavy  wagons  painted  .  . 
Hitching  posts  painted  .  . 
Hot-bed  sashes  painted.  . 
Inkwell  stands  refinished 
Knife  boxes  finished  .... 
License  frames  finished. 
Looking-glass    frames 
finished  

Cart  pole  painted  .  •  .  . 

Chairs  finished  

Checker  board  finished  .  . 
Chiffonniers  finished  
Clothes  closets  finished.. 

Meat  tubs  painted 

Dentist  chair  refinished  .  . 
Desks  finished  

Medicine  trays  finished. 
Miscellaneous  boxes   fin- 
ished   

Desks  refinished 

Diet  board  finished  

Miscellaneous       cabinets 
finished    

Doors  finished 

Dressers  finished  . 

Miscellaneous    cases   fin- 
ished                  

Electric  cabinets  .  ,  .  . 

Neck  yokes  painted  .... 

APPENDIX 


199 


Ox  carts  painted 

Piazza  floors  oiled 

Picture  frames  finished. 

Refrigerator  painted .... 

Rooms  refinished 

Screen  doors  painted .... 

Settees  refinished  

Sewing  machines  refin- 
ished   

Shafts,  new  leather 
(pairs)  

Shafts  painted  (pairs)  . . 

Shoe  boxes  finished 

Shovels  painted 

Signs  painted    

Sled  painted    


2  Sleighs  painted  7 

6  Steam  kettles  painted...  8 

3  Steel  ceilings  painted...  13 

1  Steps  painted   3 

31      Stools  finished 4 

33  Storm  porches  painted..  3 

25  Storm  windows  painted.  50 

Tables  finished   56 

7  Toilet  boxes  finished 8 

Water  tower   roof 

2  painted    1 

2  Window  frames  painted.  10 

2  Window  screens  painted.  419 

15  Window  strips  painted..  280 

85      Whiffletrees  painted 4 

1 


SHOE  DEPAETMENT 


Baseballs  resewed   15 

Baseball  gloves  repaired.  12 
Bass-drum  head  repaired  1 
Case  for  night  watch  re- 
paired    1 

Fan  belts  for  automobile  2 
Harnesses  repaired: — 

Single  harnesses  .....  30 

Double  harnesses 7 

Lacings  for  basket  ball. .  6 

Medicine  cases  made 3 

Ox  muzzle  straps  put  on  8 
Shoes  made: — 

Brogans  (pairs)    368 

Goodyear  welt  (pairs)  142 

Slippers  (pairs)    416 

Women's   (pairs)    282 

Shoes  repaired: — 

Buckles  put  on 21 

Counters    66 

Eyelets  (pairs)   38 

Heels,  leather  (pairs) .  1,624 

Heels,  rubber  (pairs) .  82 


Insoles   62 

Lacing  hooks  33 

Linings  sewed  2 

Moccasins      sewed 

(pairs)  2 

Patches,  leather 145 

Rubbers  patched    82 

Relasted  (pairs)  34 

Resoled,  leather 

(pairs)  86 

Resoled,  rubber  (pair)  1 

Soles  sewed  (pairs)  ...  3 

Tapped  (pairs) 1,442 

Tips  sewed 2 

Tongues,  new 4 

Uppers  sewed  119 

Sleigh  repaired   1 

Slippers  repaired: — 

Heels  (pairs) 641 

Patched    44 

Relasted  (pairs) 15 

Tapped  (pairs) 601 


200 


APPENDIX 


TAILORING  DEPARTMENT 


Patterns  drafted  and  made:- 

Drawers 

Dress  skirt 

Jumper    

Mitten    

Nightgown    

Overall 

Sack  coat  

Skirt    

Store  coat  

Trouser    

Vest    

Waist  

Coats  cut  out: — 

Sack   

Store,  long  

White  duck  . 


Khaki 140 

3  Dresses  cut  out: — 

3  Night    144 

4  Regular 294 

2          Strong    3 

1      Jumpers  cut  out 451 

4  Mittens  cut  out 1,038 

12  Shirts,  colored,  cut  out..  696 

5  Trousers  cut  out: — 

1         Corduroy 51 

10          Khaki  387 

8          Regular  436 

10         White  duck 14 

Vests  cut  out 137 

29T      Coats  made,  sack 326 

6  Trousers  made 39 

14      Vests  made   5 


DOMESTIC  DEPARTMENT 

MANUFACTURED 
Soap  made  (pounds) . . .     147 


Soap,     soft,    made 
(pounds)     2,575 


PICKLES,  PRESERVES,  ETC. 


Apple  jelly  (quarts)  ...  2 

Beans,  string  (quarts)  . .  41 

Blackberries  (quarts)...  112 

Blueberries  (quarts) 718 

Catsup,  tomato  (quarts)  12 
Catsup,  tomato  and  apple 

(quarts)  16 

Cherries  (quarts)  8 

Chili  sauce  (quarts) 32 

Chow-chow  (quarts) 34 

Corn,  sweet  (quarts) 344 

Crab-apple  j  elly 

(quarts)    8 


Cucumbers,    pickled 

(quarts)     96 

Cucumbers,     salt     (bar- 
rels)      5 

Currant  jelly  (quarts)..  94 

Grape  jelly   (quarts)...  42y3 

Pears   (quarts)    387 

Pears,  pickled   (quarts).  6 

Peas  (quarts)    26 

Piccalilli  (gallons) Ill 

Pickles   (gallons)    57 

Pickles,  sweet  (gallons).  16 

Plums  (quarts)  20 


APPENDIX  201 

Pumpkin  (quarts)   17  Tomatoes,    canned 

Raspberries    (quarts) ...  74          (quarts)    548 

Rhubarb  (quarts)    89  Tomatoes,  sweet  pickled 

Strawberries  (quarts) ...  116          (gallons)   190 


PRODUCTS  OF  FARM, 
BY  COLONIES 

BELCHER  COTTAGE 

Apples,  firsts,  barrels,  25,  at  $2 $  50.00 

Beans,  dry,  bushels,  32,  at  $2.65 84.80 

Beans,  shell,  bushels,  10,  at  $0.85 8.50 

Beans,  string,  bushels,  57y2,  at  $0.85 48.87 

Beet  greens,  bushels,  8,  at  $0.40 3.20 

Beets,  bushels,  26  MJ,  at  $0.60 15.90 

Blackberries,  quarts,  28,  at  $0.12 3.36 

Blueberries,  quarts,  205,  at  $0.14 28.70 

Cabbage,  pounds,  4,533,  at  $13  a  ton 29.46 

Carrots,  bushels,  90^,  at  $0.60 54.30 

Celery,  boxes,  8,  at  $0.75 6.00 

Chard,  bushels,  91,  at  $0.40 36.40 

Chicken,  pounds,  282,  at  $0.24 67.68 

Cordwood,  cords,  65,  at  $5 325.00 

Corn,  green,  bushels,  47,  at  $0.60 2B.20 

Cucumbers,  boxes,  8,  at  $1 8.00 

Eggs,  dozen,  1,065 y2,  at  $0.25 266.35 

Ensilage,  corn,  tons,  195,  at  $5 975.00 

Fodder,  corn,  tons,  6,  at  $5 30.00 

Fodder,  rye,  tons,  1%,  at  $5 8.75 

Fodder,  Hungarian  millet,  tons,  2%,  at  $5. .  12.50 

Fodder,  oats  and  peas,  tons,  1%,  at  $5....  7.50 

Fodder,  green  hay,  tons,  11%,  at  $5 56.25 

Fowl,  pounds,  229  y2,  at  $0.17 39.01 

Hay,  English,  tons,  26,  at  $20.75 539.50 

Hay,  Hungarian  millet,  tons,  2,  at  $12 24.00 

Lettuce,  boxes,  43,  at  $0.25 10.75 

Mangel-wurzels,  bushels,  64y2,  at  $0.25 16.12 

202 


APPENDIX 


203 


Manure,  cords,  220,  at  $6 $1,320.00 

Manure,  hen,  barrels,  20,  at  $0.75 15.00 

Onions,  bushels,  15%,  at  $0.60 9.40 

Parsnips,  bushels,  8%,  at  $0.65 5.68 

Peas,  green,  bushels,  14,  at  $2 28.00 

Potatoes,  bushels,  65,  at  $0.55 35.75 

Pumpkins,  pounds,  302,  at  $0.01  y2 4.53 

Radishes,  bushels,  2,  at  $0.75 1.50 

Rhubarb,  pounds,  56,  at  $0.01 .56 

Spinach,  bushels,  11,  at  $0.35 3.85 

Scullions,  bushels,  8y2,  at  $0.25 2.13 

Squash,  winter,  tons,  1%,  at  $20 27.50 

Tomatoes,  ripe,  bushels,  17,  at  $1 17.00 

Tomatoes,  green,  bushels,  20,  at  $1 20.00 

Turnips,  bushels,  150%,  at  $0.75 112.68 

Turnip  greens,  bushels,  38,  at  $0.25 9.50 

$4,397.18 

FAIHVIEW  COTTAGE 

Apples,  barrels,  1%,  at  $2 $  3.33 

Blueberries,  quarts,  150,  at  $0.14 21.00 

Eggs,  dozen,  73%,  at  $0.25 18.46 

Pears,  bushels,  5y2,  at  $0.75 4.13 

Turnips,  bushels,  20,  at  $0.75 15.00 

$     61.99 

GARDEN  AT  RECEIVING  GROUP 

Asparagus,  box,  1,  at  $4 $  4.00 

Beans,  shell,  bushels,  65y2,  at  $0.85 55.67 

Beans,  string,  green,  bushels,  66%,  at  $0.85.  56.74 

Beans,  string,  wax,  bushels,  10,  at  $0.85 8.50 

Beets,  bushels,  89  y2,  at  $0.60 53.70 

Beet  greens,  bushels,  332,  at  $0.40 132.80 

Blackberries,  quarts,  129,  at  $0.12 15.48 

Blueberries,  quarts,  1,147,  at  $0.14 160.58 

Cabbage,  pounds,  15,357,  at  $13  ton 99.82 

Carrots,  bushels,  56,  at  $0.60 33.60 

Cauliflower,  bushels,  205/8,  at  $0.55 11.34 

Celery,  early,  boxes,  58^,  at  $0.75 43.75 

Celery,  late,  boxes,  66%,  at  $0.75 50.00 


204  APPENDIX 

Chard,  bushels,  140,  at  $0.40 $  66.00 

Cordwood,  cords,  35,  at  $5 175.00 

Corn,  green,  bushels,  551,  at  $0.60 330.60 

Cucumbers,  boxes,  79%,  at  $1 79.75 

Currants,  quarts,  373,  at  $0.05 18.65 

Fodder,  cabbage  and  turnip  tops,  tons,  3, 

at  $5 15.00 

Fodder,  corn,  tons,  16,  at  $5 80.00 

Gooseberries,  quarts,  9,  at  $0.10 .90 

Hay,  meadow,  tons,  4,  at  $11 44.00 

Lettuce,  boxes,  82,  at  $0.25 20.50 

Parsley,  bushels,  10%,  at  $0.65 7.00 

Parsnips,  bushels,  30,  at  $0.65 19.50 

Peas,  green,  bushels,  56,  at  $2 112.00 

Peppers,  green,  bushels,  3,  at  $0.50 1.50 

Potatoes,  bushels,  64  y2,  at  $0.55 35.47 

Pumpkins,  pounds,  800,  at  $0.01  ya 12.00 

Radishes,  bushels,  59,  at  $0.75 44.25 

Raspberries,  quarts,  120,  at  $0.18 21.75 

Rhubarb,  pounds,  387,  at  $0.01 3.87 

Spinach,  bushels,  43,  at  $0.35 15.05 

Squash,  summer,  barrels,  5%0,  at  $0.60 3.06 

Squash,  winter,  pounds,  2,146,  at  $20  per  ton  21.46 

Strawberries,  quarts,  1,056,  at  $0.12 126.72 

Tomatoes,  green,  bushels,  74,  at  $1 74.00 

Tomatoes,  ripe,  bushels,  182%,  at  $1 182.25 

Turnips,  bushels,  248%,  at  $0.75 186.38 

$2,412.67 

GARDNER  COTTAGES 

Apples,  cider,  barrels,  5%,  at  $0.30 $  1.73 

Apples,  seconds,  barrels,  5,  at  $1.50 7.50 

Apples,  firsts,  barrels,  7y2,  at  $2 15.00 

Beans,  shell,  bushels,  14y2,  at  $0.85 12.33 

Beans,  string,  bushels,  21  y2,  at  $0.85 18.28 

Beets,  bushels,  24y8,  at  $0.60 14.47 

Beet  greens,  bushels,  8,  at  $0.40 3.20 

Blueberries,  quarts,  683,  at  $0.14 95.62 

Cabbage,  pounds,  1,154,  at  $13  a  ton 7.50 

Carrots,  bushels,  19634,  at  $0.60 118.05 


APPENDIX  205 

Chard,  bushels,  29,   at  $0.40 $     11.60 

Cordwood,  cords,  130,  at  $5 650.00 

Corn,  green,  bushels,  27,  at  $0.60 16.20 

Cucumbers,  pickling,  pecks,  133^,  at  $0.35 . .  46.66 

Cucumbers,  boxes,  35y2,  at  $1 35.50 

Eggs,  dozen,  809%2»  at  $0.25 202.31 

Ensilage,  corn,  tons,  60,  at  $5 300.00 

Fodder,  oats  and  peas,  tons,  13,  at  $5 65.00 

Fodder,  turnip  tops,  tons,  2,  at  $5 10.00 

Hay,  English,  tons,  30,  at  $20.75 622.50 

Hay,  oats  and  peas,  ton,  1,  at  $15 15.00 

Lettuce,  boxes,  37,  at  $0.25 9.25 

Mangel-wurzels,  bushels,  118y2,  at  $0.25....  29.63 

Manure,  cords,  45,  at  $6 270.00 

Manure,  hen,  barrels,  12,  at  $0.75 9.00 

Milk,  quarts,  20,029,  at  $0.05% 1,134.98 

Onions,  bushels,  82y2,  at  $0.60.... 49.50 

Peas,  green,  bushels,  14,  at  $2 28.00 

Potatoes,  bushels,  2,598,  at  $0.55 1,428.90 

Radishes,  bushels,  6%,  at  $0.75 4.69 

Raspberries,  quarts,  14,  at  $0.18 2.52 

Rhubarb,  pounds,  136,  at  $0.01 1.36 

Scullions,  bushels,  10y2,  at  $0.25 2.62 

Spinach,  bushels,  11,  at  $0.35.. 3.85 

Squash,  summer,  barrels,  2%0,  at  $0.60 1.26 

Squash,  winter,  tons,  1%,  at  $20 32.00 

Tomatoes,  green,  bushels,  6,  at  $1 6.00 

Tomatoes,  ripe,  bushels,  14%,  at  $1 14.75 

Turnips,  bushels,  304y2,  at  $0.75 228.37 

Turnip  greens,  bushels,  94,  at  $0.25 23.50 

$5,548.63 

HILLCREST  COTTAGE 

Apples,  firsts,  148%,  at  $2 $    297.20 

Apples,  seconds,  barrels,  22,  at  $1.50 33.00 

Apples,  cider,  barrels,  20%,  at  $0.30 6.24 

Beans,  string,  bushels,  14%,  at  $0.85 12.11 

Beans,  shell,  bushels,  14%,  at  $0.85 12.11 

Beans,  dry.  bushels,  7%,  at  $2.65 20.76 

Beets,  bushels,  20%,  at  $0.60 12.15 


206  APPENDIX 

Blackberries,  quarts,  15,  at  $0.12 $       1.80 

Blueberries,  quarts,  273,  at  $0.14 38.23 

Cabbage,  pounds,  729,  at  $13  per  ton 4.74 

Capons,  pounds,  66%,  at  $0.29 19.35 

Carrots,  bushels,  23J&,  at  $0.60 13.92 

Celery,  boxes,  5,  at  $0.75 3.75 

Chard,  bushels,  5y2,  at  $0.40 2.20 

Cherries,  quarts,  8,  at  $0.12 .96 

Chicken,  pounds,  666y8,  at  $0.24 160.05 

Cordwood,  cords,  80,  at  $5 400.00 

Corn,  green,  bushels,  10^,  at  $0.60 6.10 

Cucumbers,  boxes,  4,y12,  at  $1 4.08 

Eggs,  dozen,  1,702%2,  at  $0.25 425.65 

Fodder,  corn,  tons,  52,  at  $5 260.00 

Fodder,  oats  and  peas,  tons,  10,  at  $5 50.00 

Fowl,  pounds,  254%,  at  $0.17 43.24 

Grapes,  pounds,  109,  at  $0.04 4.36 

Hay,  alfalfa,  pounds,  300,  at  $23  per  ton. .  3.45 

Hay,  English,  tons,  5,  at  $20.75 103.75 

Lettuce,  boxes,  1 i/2,  at  $0.25 .38 

Mangel-wurzels,  bushels,  78,  at  $0.25 19.50 

Manure,  cords,  11,  at  $6 66.00 

Manure,  hen,  barrels,  22,  at  $0.75 16.50 

Milk,  quarts,  6,352,  at  $0.05% 359.95 

Onions,  bushels,  120,  at  $0.60 72.00 

Parsnips,  bushels,  6,  at  $0.65 3.90 

Pears,  bushels,  4,  at  $0.75 3.00 

Peas,  green,  bushels,  11,  at  $2 22.00 

Potatoes,  bushels,  255,  at  $0.55 140.25 

Pumpkins,  pounds,  109,  at  $0.01  % 1.64 

Radishes,  bushel,  y2,  at  $0.75 .38 

Raspberries,  quarts,  53,  at  $0.18 9.54 

Scullions,  bushels,  1114,  at  $0.25 2.81 

Squash,  summer,  barrels,  li/£,  at  $0.60 .80 

Squash,  winter,  pounds,  342,  at  $20  per  ton.  3.42 

Strawberries,  quarts,  46,  at  $0.12 5.52 

Tomatoes,  green,  bushels,  4,  at  $1 4.00 

Tomatoes,  ripe,  bushels,  17y2,  at  $1 17.50 

Turnips,  bushels,  149,  at  $0.75 111.75 

$2,800.03 


APPENDIX  307 

HIGHLAND  COTTAGE 

Beans,  string,  bushels,  3,  at  $0.85 $  2.55 

Blackberries,  quarts,  3,  at  $0.12 .36 

Blueberries,  quarts,  363,  at  $0.14 50.82 

Tomatoes,  green,  bushels,  7,  at  $1 7.00 

$     60.73 

VALLEY  FARM  COTTAGES 

Apples,  barrels,  53,  at  $2 $  106.00 

Asparagus,  box,  1,  at  $4 4.00 

Beans,  string,  bushels,  20y2,  at  $0.85 17.43 

Beans,  dry,  bushels,  7y2,  at  $2.65 19.87 

Beets,  bushels,  96 y2,  at  $0.60 57.90 

Beet  greens,  bushels,  21,  at  $0.40 8.40 

Blackberries,  quarts,  75,  at  $0.12 9.00 

Blueberries,  quarts,  253,  at  $0.14 35.42 

Cabbage,  pounds,  1,738,  at  $13  per  ton 11.30 

Carrots,  bushels,  182%,  at  $0.60 109.50 

Celery,  boxes,  37,  at  $0,75 27.75 

Chard,  bushels,  52,  at  $0.40 20.80 

Cherries,  quarts,  12,  at  $0.12 1.44 

Chicken,  pounds,  121,  at  $0.24 29.04 

Cordwood,  cords,  75,  at  $5 375.00 

Corn,  green,  bushels,  63,  at  $0.60 37.80 

Crab  apples,  barrel,  %,  at  $2.25 1.80 

Cucumbers,  boxes,  6y8,  at  $1 6.13 

Currants,  quarts,  2,  at  $0.05 .10 

Eggs,  dozen,  1,414%,  at  $0.25 353.71 

Ensilage,  corn,  tons,  120,  at  $5 600.00 

Fodder,  millet,  tons,  8,  at  $5 40.00 

Fodder,  oats  and  peas,  tons,  10,  at  $5 50.00 

Fowl,  pounds,  218,  at  $0.17 37.06 

Grapes,  pounds,  150,  at  $0.04 6.00 

Hay,  English,  tons,  25,  at  $20.75 518.75 

Hay,  meadow,  tons,  6,  at  $11 66.00 

Hay,  oats  and  peas,  tons,  14,  at  $15 210.00 

Lettuce,  boxes,  98 y2,  at  $0.25 24.62 

Mangel-wurzels,  bushels,  304,  at  $0.25 76.00 

Manure,  cords,  30,  at  $6 180.00 

Manure,  hen,  barrels,  25,  at  $0.75 18.75 


208  APPENDIX 

Milk,  quarts,  6,788,  at  $0.05% $  384.65 

Onions,  bushels,  31  y2,  at  $0.60 18.90 

Parsnips,  bushels,  25,  at  $0.65 16.25 

Peaches,  bushel,  1,  at  $2 2.00 

Pears,  bushels,  2,  at  $0.75 1.50 

Peas,  green,  bushels,  4y2,  at  $2 9.00 

Plums,  bushel,  1,  at  $1 1.00 

Potatoes,  bushels,  1,504,  at  $0.55 827.20 

Radishes,  bushels,  2y2,  at  $0.75 1.87 

Raspberries,  quarts,  31,  at  $0.18 5.58 

Rhubarb,  pounds,  30,  at  $0.01 .30 

Rowen,  ton,  y2,  at  $10 5.00 

Scullions,  bushels,  21%,  at  $0.25 5.45 

Squash,  summer,  barrels,  9%,  at  $0.60 5.52 

Squash,  winter,  pounds,  1,050,  at  $20  per  ton  10.50 

Straw,  rye,  tons,  3,  at  $15 45.00 

Tomatoes,  bushels,  22 y2,  at  $1 22.50 

Turnips,  bushels,  169,  at  $0.75 126.75 

$4,548.54 

WESTMINSTER  COTTAGES 

Apples,  barrels,  94,  at  $2 $  188.00 

Asparagus,  boxes,  8,  at  $4 32.00 

Beans,  dry,  bushels,  30,  at  $2.65 79.50 

Beans,  shell,  bushels,  4,  at  $0.85 3.40 

Beans,  string,  bushels,  24,  at  $0.85 20.40 

Beets,  bushels,  39%,  at  $0.60 23.80 

Beet  greens,  bushels,  21,  at  $0.40 8.40 

Blackberries,  quarts,  374>  at  $0.12 44.88 

Blueberries,  quarts,  785,  at  $0.14 109.90 

Cabbage,  pounds,  2,599,  at  $13  per  ton 16.89 

Carrots,  bushels,  154%,  at  $0.60 92.88 

Cider,  gallons,  440,  at  $0.15 66.00 

Chard,  bushels,  36,  at  $0.40 14.40 

Chicken,  pounds,  85%,  at  $0.24 20.58 

Cordwood,  cords,  115,  at  $5 575.00 

Corn,  green,  bushels,  36,  at  $0.60 21.60 

Cucumbers,  boxes,  32,  at  $1 32.00 

Cucumbers,  pickling,  pecks,  15,  at  $0.35. . . .  5.25 


APPENDIX  209 

Dandelions,  bushels,  7,  at  $0.35  $       2.45 

Ensilage,  corn,  tons,  60,  at  $5 300.00 

Eggs,  dozen,  1,018%,  at  $0.25 254.58 

Fodder,  barley,  ton,  1,  at  $6 6.00 

Fodder,  cabbage,  ton,  1,  at  $5 5.00 

Fodder,  corn,  tons,  8,  at  $5 40.00 

Fodder,  millet,  tons,  2,  at  $5 10.00 

Fodder,  oat,  tons,  2,  at  $5 10.00 

Fodder,  rye,  tons,  7,  at  $5 35.00 

Fowl,  pounds,  111,  at  $0.17 18.87 

Grapes,  pounds,  165,  at  $0.04 6.60 

Hay,  bluejoint,  tons,  11,  at  $11 121.00 

Hay,  English,  tons,  24,  at  $20.75 498.00 

Hay,  millet,  tons,  2,  at  $12 24.00 

Hay,  rye,  tons,  6,  at  $15 90.00 

Lettuce,  boxes,  13,  at  $0.25 3.25 

Mangel-wurzels,  bushels,  63,  at  $0.25 15.75 

Manure,  cords,  65,  at  $6 390.00 

Manure,  hen,  barrels,  14,  at  $0.75 10.50 

Milk,  quarts,  20,180,  at  $0.05% 1,143.53 

Muskmelons,  crates,  3,  at  $1 3.00 

Onions,  bushels,  117,  at  $0.60 70.20 

Parsnips,  bushels,  20,  at  $0.65 13.00 

Pears,  bushels,  14,  at  $0.75 10.50 

Peas,  green,  bushels,  23  at  $2 46.00 

Posts,  fence,  175,  at  $0.20 35.00 

Potatoes,  bushels,  971,  at  $0.55 534.05 

Pumpkins,  pounds,  2,500,  at  $0.01  y2 37.50 

Radishes,  bushels,  3y2,  at  $0.75 2.62 

Rhubarb,  pounds,  1,125,  at  $0.01 11.25 

Spinach,  bushels,  12,  at  $0.35 4.20 

Squash,  summer,  barrels,  6,  at  $0.60 3.60 

Squash,  summer,  barrels,  6,  at  $0.60 3.60 

Squash,  winter,  pounds,  2,340  at  $20  per  ton  23.40 

Stakes,  fence,  250,  at  $0.10  each 25.00 

Strawberries,  quarts,  327,  at  $0.12 39.24 

Tomatoes,  green,  bushels,  8,  at  $1 8.00 

Tomatoes,  ripe,  bushels,  7,  at  $1 7.00 

Turnips,  bushels,  85ylo,  at  $0.75 63.83 


210  APPENDIX 

GENERAL 

Beef,  cow,  pounds,  6,216,  at  $0.09 $  $59.44 

Beef,  steer,  pounds,  3,763,  at  $0.12  ya 470.38 

Calf  skin,  1,  at  $0.75 .75 

Calves  sold,  26,  at  $4 104.00 

Calf  sold,  1,  at  $7 7.00 

Calf  sold,  1,  at  $6 6.00 

Guinea  pigs  sold,  392 118.70 

Hides,  cow,  green,  pounds,  754,  at  $0.12 90.48 

Hides,  steer,  green,  pounds,  375,  at  $0.12 45.00 

Ice,  tons,  842,  at  $3 2,526.00 

Lamb,  pounds,  544,  at  $0.16 87.04 

Lumber,  oak,  chestnut,  maple,  10,000  feet,  at 

$25  M 250.00 

Lumber,  hemlock,  spruce,  pine,  56,000  feet, 

at  $20  M  1,120.00 

Milk,  quarts,  111,200,  at  $0.05% 6,301.33 

Pigs  sold,  3 20.00 

Pork,  fresh,  pounds,  16,009,  at  $0.12 1,921.08 

Sawdust,  cords,  16,  at  $2 32.00 

Slabs,  cords,  16,  at  $2 32.00 

Stone,  crushed,  tons,  1,295,  at  $1 1,295.00 

$14,986.20 


Total  farm  products $40,092.70 

LIVE  STOCK 

Bulls,  2  $  250.00 

Calves,  15,  at  $26 390.00 

Cockerels,  100,  at  $0.50 50.00 

Cows,  47,  at  $80 3,760.00 

Guinea  pigs,  187,  at  $0.30 56.10 

Heifers  (one-year),  9,  at  $46 414.00 

Heifer   (two-year)  ,1 50.00 

Hens,  405,  at  $0.75 303.75 

Hogs,  13,  at  $25 325.00 

Horses,  18   3,280.00 

Oxen,  15  1,725.00 

Pigs,  8,  at  $5 40.00 


APPENDIX  211 

Pullets,  286,  at  $0.60    $  171.60 

Roosters,  9,  at  $1.25 11.25 

Sheep,  5,  at  $15 75.00 

Shoates,  52,  at  $10 520.00 

$11,421.70 


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